On September 8, 2010, the OIG released Advisory Opinion 10-14 regarding an arrangement in which a sleep lab management company (the “Requestor”) provides a Hospital sleep lab with all of the equipment, technology, supplies, and staff necessary to operate a sleep testing laboratory. No physicians have any ownership interest in…
Sleep Solutions, Inc. (“Sleep Solutions”)–a Maryland diagnostic service provider of in-home sleep tests–settled with the United States for $500,000 to settle claims that it violated the False Claims Act by submitting false claims to TRICARE and the Federal Employees Health Benefit Program. The United States contends that from February 2003…
The Federal Trade Commission (“FTC”), Centers for Medicare and Medicaid Services (“CMS”), and Department of Health and Human Services Office of Inspector General (“OIG”) have announced their plans to co-host an October 5th workshop on accountable care organizations (“ACOs”). According to a September 8th News Release, the workshop is intended…
CMS recently issued guidance on Section 2302 of the Patient Protection and Affordable Care Act–the 2010 healthcare reform law. “Section 2302 of the law amends sections 1905 (o)(1) and 2110(a)(23) of the Social Security Act to remove the prohibition of receiving curative treatment upon the election of the hospice benefit…
The OIG released Advisory Opinion 10-13 on August 31, 2010, concerning a proposed-arrangement where a hospital would be providing pre-authorization services for diagnostic imaging. Requestor, a non-profit hospital, provides diagnostic imaging services to patients. Because many commercial insurers have begun requiring pre-authorization prior to covering diagnostic imaging services, the hospital…
Founding partner, Adrienne Dresevic, Esq. was quoted in Kaiser Health News on August 23, 2010 in an article on the recent regulations pertaining to physician disclosure requirements involving imaging machines. Dresevic often writes articles and speaks across the nation about the laws and policies surrounding imaging arrangements. For more information…
Dr. Sam Smith Hill, III’s 2008 healthcare fraud conviction was affirmed by the 5th Circuit on August 25, 2010 (US v. Hill, No. 09-40749 (5th Cir. Aug. 25, 2010). Found guilty in five counts of healthcare fraud by a jury, Dr. Hill’s indictment alleged that he fraudulently billed Medicaid from…
A bill introduced in the Senate on August 5, 2010 would set forth minimum credentialing standards for medical personnel who “perform or plan” medical imaging or radiation therapy procedures. The Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act, introduced by Sen. Harkin (D-IA) and Sen.…
CMS has issued new guidance expanding on the Fee-for-Service Reimbursement instructions detailed in CR 6960 (which HLP had blogged about here). The earlier change request explained the basic standards stemming from the Section 6404 of the Patient Protection and Affordable Care Act of 2010: services billed more than one year…
As HLP reported, in April, CMS requested that the RAC for Region D remove an anesthesia care package it had posted to its website. Now, the issue has been re-posted, with some changes: Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services,…