A Florida medical center sued for violations of the False Claims Act settled yesterday with the U.S. Justice Department for $12 million. The case was a result of a whistleblower lawsuit filed by the former oncology director of the provider, the Melbourne Internal Medicine Associates P.A. (MIMA). MIMA and its former medical director and practicing […]
As HLP previously reported, in December, CMS issued MLN Matter 6740 announcing that consultation codes would no longer be used to reflect the different locations where services were provided. This week, CMS issued additional guidance regarding billing for those services that would previously been coded as consultations. This guidance includes a Questions and Answers on […]
Recent Medicare regulations regarding ownership changes for HHAs have been the source of controversy and confusion. After numerous attempts by HLP founding partner Robert Iwrey, Esq. to obtain clarification regarding enforcement of these regs, Rob was pleased to receive an email this morning from Frank Whelan, a CMS adminstrator with the Division of Provider and […]
A legal ruling finding that the Red Flag Rules promulgated by the Federal Trade Commission (“FTC”) do not apply to the profession of law has raised new hope that physicians may find a similar exemption. In a final rule published in 2007 under the Fair and Accurate Credit Transaction Act of 2003, the FTC issued […]
A Florida Appeals Court upheld a ruling last month that a hospital-based but non-contracted provider may not balance bill patients for amounts unpaid by the patients’ HMO, when the HMO has accepted liability. The text of the ruling can be found here. In this case, the patients, each a subscriber to one HMO, received pre-authorization […]
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires the Secretary to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners, and Independent Diagnostic Testing Facilities, that furnish the technical component of advanced diagnostic imaging services. Advanced diagnostic imaging services include diagnostic magnetic resonance imaging (MRI), computed tomography […]
CMS rescinded a change order affecting the use of place of service (“POS”) codes used for the interpretation of diagnostic tests. Originally issued on December 11, 2009, the rescinded Change Request (“CR”) led to significant confusion about the POS for reporting the reading of diagnostic tests. MLN Matters 6375, which explained the CR, required providers […]
The home health world has been turned upside down. As many are aware, new regulations have been implemented that affect ownership changes for home health agencies (“HHAs”). On January 21, 2010, CMS published a “Medicare Learning Network Provider Inquiry Assistance.” This publication clearly states that any “ownership change” within 36 months of the Medicare enrollment […]
CMS announced new demonstration programs it plans to implement to “identify, develop, test, and disseminate major and multi-faceted improvements to the health care system.” The Medicare Modernization Act requires that Medicare conduct a five-year demonstration program to achieve four main goals: (1) to improve patient safety; (2) to enhance quality; (3) to increase efficiency; and […]
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 Human Services (HHS) Secretary, Kathleen […]
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