On December 18, 2014, a U.S. District Court judge dismissed a lawsuit the American Hospital Association (“AHA”) filed against the Department of Health and Human Services (“HHS”) seeking HHS to process their administrative appeals in accordance with statutory timelines. In its order, the Court acknowledged that the Office of Medicare Hearings and Appeals (“OMHA”) is […]
The Centers for Medicare and Medicaid Services (“CMS”) is charged with the implementation of the Physician Payments Sunshine Act. CMS developed the Open Payments Program to keep track of data on consulting fees, research grants, travel reimbursements and other gifts made by certain manufacturers and organizations to physicians and teaching hospitals. Since the implementation of […]
On October 31, 2014, the Department of Health and Human Services (“HHS”) Office of the Inspector General (“OIG”) released its Fiscal Year (“FY”) 2015 Work Plan summarizing its new and ongoing investigative, enforcement, and compliance priorities for the upcoming fiscal year. For FY 2014, the OIG reported recoveries of over $4.9 billion, consisting of nearly […]
In a letter dated December 4, 2014, the American Hospital Association (“AHA”) submitted comments in response to the Office of Medicare Hearings and Appeals (“OMHA”) request for information on current and potential initiatives to resolve the current backlog of appeals at the administrative law judge (“ALJ”) level. In its letter, the AHA takes the position […]
In a letter dated December 3, 2014, the American Medical Association (“AMA”) urged the Centers for Medicare and Medicaid Services (“CMS”) to resolve the two-year backlog of Medicare and Medicaid appeals. The AMA noted that while it appreciated the recent efforts of the Office of Medicare Hearings and Appeals (“OMHA”) to address the issue, the […]
In the December 2014 issue of BCBSM’s The Record, BCBSM reminds pharmacies that the following documents should be available to BCBSM if contacted for an audit in order to avoid preventable findings which could result in significant financial recoupment: Prescriptions. Original prescriptions for written and verbal orders must be submitted by the pharmacy printed copies […]
On November 19, 2014, the House Ways & Means health subcommittee Chair Kevin Brady (R-TX) introduced draft legislation that would revamp the Medicare payment structure for short-term hospital admissions, aiming to resolve the backlog of appeals and to improve the current Recovery Audit Contractor (“RAC”) program. The draft bill–called the Hospital Improvement for Payment (“HIP”) […]
On November 7, 2014, the Professional Services Council (“PSC”), a national trade association of the government technology and professional services industry, filed an amicus brief with the U.S. Court of Appeals for the Federal Circuit to overturn a ruling which would allow Centers for Medicare and Medicaid (“CMS”) to modify payment terms for Recovery Auditor […]
The Health Law Partners, P.C. is proud to announce that various attorneys in the firm contributed healthcare-related articles that were included in the newly-published Fourth Edition of the Legal Manual for New York Physicians, a joint publication of the New York State Bar Association and the Medical Society of the State of New York. The […]
On September 30, 2014, the Centers for Medicare & Medicaid Services released the first round of “open payments” data pursuant to the Sunshine Act. Currently, the Open Payments Program lists data on consulting fees, research grants, travel reimbursements, and other gifts the healthcare industry provided to physicians and teaching hospitals during the last five months […]
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