Over 250,000 Americans fall victim to medical identity theft each year, according to an article by the New York Times, and the increased use of electronic medical records with less than adequate privacy protection has allowed this number to rise. Medical identity theft is easily carried out when thieves attain someone’s name and Social Security […]
Out of network patient billing gives rise to many issues. As a result, some health care providers, including physician groups and ambulatory surgery centers, have struggled with the decision to participate or not to participate in various insurance plans. In addition to the political considerations that arise, various state and federal laws also may apply […]
The Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)’s formation was announced today by US Attorney General Eric Holder and U.S. Secretary of Health and Human Services (“HHS”) Kathleen Sebelius. The purpose of HEAT is to assist in the crackdown on Medicare fraud. HEAT will be comprised of members of both the Department of […]
Ambulatory Surgery Centers (“ASCs”) need to take note of additional federal Conditions for Coverage (“CFCs”) governing patient rights that took effect May 18, 2009. The Amendments to these CFCs, which the Centers for Medicare and Medicaid Services (CMS) published on November 18, 2008, are codified at “Part 416 – Ambulatory Surgical Services” (42 CFR 416.50). […]
The Michigan Medicaid False Claims Act (FCA) has been found by the Department of Health and Human Services (HHS) Office of Inspector General (OIG), which has the authority to make this determination, to meet the requirements of the Deficit Reduction Act (DRA). Section 6031 of the DRA creates a financial incentive for States to enact […]
“Red Flag Rules” enforcement has been delayed by the Federal Trade Commission (“FTC”) until August 1, 2009. On the eve of the scheduled May 1, 2009 enforcement date for the Red Flag Rules, the FTC announced that it is delaying the enforcement date until August 1, 2009. The purpose of this extension is to give […]
The Medicare Recovery Audit Contractor Program (“RAC”) program has been made permanent and is expanding nationwide, pursuant to Section 302 of the Tax Relief and Health Care Act of 2006. Medicare providers and suppliers in Michigan are some of the first in the country that will experience RAC audits and potential claim denials. Pursuant to […]
A recent Federal appeals court decision paved the way for a whistleblower to proceed with a False Claims Act (“FCA”) case involving allegations of Stark and Anti-kickback Statute violations regarding an exclusive anesthesia coverage agreement and pain management services arrangement. This case is important as it highlights how courts and enforcement officials may apply Stark […]
As part of the OIG 2008 Work Plan, the OIG reviewed Medicare payments for interventional pain management procedures in connection with Section 1862(a)(1)(A) of the Social Security Act, which requires that services must be medically necessary. The OIG noted that interventional pain management was a growing specialty and that Medicare paid almost $2 billion for […]
As the “Red Flag Rules” enforcement date of May 1, 2009 quickly-approaches, health care providers need to get prepared. The Red Flag Rules require financial institutions and “creditors” to develop and implement identity theft prevention programs that provide for identification, detection, and response to patterns, practices or specific activities (known as red flags) that could […]
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