On December 28, 2009, the American Society of Nuclear Cardiology (ASNC), joined by the American College of Cardiology (ACC), the Florida ACC Chapter, the Association of Black Cardiologist, and the Cardiology Advocacy Alliance, filed a complaint, as well as motions for a preliminary injunction and expedited discovery, against Health and…
Shortly before the holidays, Boston Scientific agreed to pay $22 million to resolve allegations that its subsidiary, Guidant, paid kickbacks to physicians to induce them to use Guidant pacemakers and defibrillators, in addition to a previous agreement to pay a $296 million fine resulting from a criminal investigation relating to…
Effective January 1, 2010, the 2010 Outpatient Prospective Payment System (“OPPS”) amends the prior hospital outpatient supervision requirements. Reaffirming that Medicare will only cover outpatient therapeutic services that are furnished in the hospital (“in the hospital” defined as the areas included in the main buildings of the hospital that are…
On December 30, 2009, CMS announced a proposed rule to implement provisions of the Recovery Act that provide incentive payments for the meaningful use of certified EHR technology. The proposed rule outlines provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. The…
Genesys Health System in Genesee County settled a claim by the U.S. Department of Justice that it violated the False Claims Act by billing Medicare at higher rates for evaluation and management services than were actually provided to cardiology patients. The fraud allegations, which were initiated by a whistleblower lawsuit,…
In the new 2010 physician fee schedule, the Centers for Medicare and Medicaid Services (CMS) has replaced consultation codes with an increase in work relative value units (RVUs). Effective January 1, 2010, CMS will no longer recognize consultation codes that reflect various places of service (with the exception of telehealth…
In a recent survey by the American College of Physician Executives, 97% of respondents–doctors and nurses–reported behavior problems between doctors and nurses. This disruptive behavior, which over 55% of respondents reported happens at least monthly, included degrading comments or insults, inappropriate joking, and refusing to speak to or work with…
Those monitoring regulations effective January 1, 2010 related to CMS payment policy for teaching CRNAs involved in two (2) concurrent anesthesia cases with student nurse anesthetists were likely confused by a November 20, 2009 CMS MLN Matters article that appeared to contradict the new regulatory language and CMS Transmittal 1859.…
On December 1, 2009, the Sixth Circuit affirmed the conviction of Dr. Jorge A. Martinez, an anesthesiologist, who was charged with illegally distributing controlled substances, mail fraud, wire fraud, and healthcare fraud, including two counts that resulted in the death of patients. In 2002, the FBI began investigating Dr. Martinez’s…
Requirements for Medicare coverage of Inpatient Rehabilitation Services will undergo a number of changes, effective January 1, 2010. Centers for Medicare and Medicaid Services (CMS) released a transmittal on October 23, 2009 detailing these changes, which include several new requirements for the patient admission process and ongoing recordkeeping. Admission will…