In a memorandum to Office of Medicare Hearings and Appeals (“OMHA”) applicants, the Centers for Medicare and Medicaid Services (“CMS”) announced that it will temporarily suspend the assignment of new requests for Administrative Law Judge (“ALJ”) hearings for two years. CMS stated in the memo that the reason for the temporary suspension is the increasing […]
On December 26, 2013, the Department of Health and Human Services (“HHS”) and Adult & Pediatric Dermatology, P.C. (“APDerm”) agreed to settle potential violations of the HIPAA Privacy, Security, and Breach Notification Rules for $150,000. In addition the $150,00 settlement, APDerm will also be required to implement a corrective action plan to correct deficiencies in […]
On January 14, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced a new policy regarding requests made under the Freedom of Information Act (“FOIA”) on amounts paid to individual physicians under the Medicare program. This notice reverses more than 30 years of prior policy. CMS will now make case-by-case determinations as to whether […]
On December 27, 2013, the Centers for Medicare & Medicaid Services (“CMS”) issued revisions to Chapter 15 of the Medicare Program Integrity Manual. The key clarifications/updates of interest to providers include: • Instructions for processing disclosures of final adverse actions reported by providers and suppliers or law enforcement agencies; • New instructions for the maintenance […]
On December 23, 2013, the Department of Health and Human Services (“HHS”) announced the participation of 123 new Accountable Care Organizations (“ACOs”) in the Medicare Shared Savings Program. This step is intended to further advance Medicare’s goal of providing its beneficiaries with access to high-quality, coordinated care nationwide. The newly established Medicare ACOs include a […]
On December 10, 2013, Minnesota Congressman Erik Paulsen introduced a bill into the House of Representatives that he believes will streamline and enhance the U.S. healthcare delivery system. The bill, entitled the “Diagnostic Imaging Utilization Act of 2013” directs Medicare to develop a system whereby physicians ordering advanced imaging (“AI”) would receive electronic clinical guidance […]
The Centers for Medicare and Medicaid Services (“CMS”) has released the final version of its 2014 Medicare Physician Fee Schedule (“MPFS”) that determines physician reimbursement for services furnished to Medicare beneficiaries. In addition to adjusting the various formulas that are used to determine payment amounts, the MPFS includes a number of changes to policies and […]
On December 2, 2013, the Office of Inspector General (“OIG”) published an advisory opinion in which it considered whether a charitable organization’s (the “Requestor”) proposal to provide monetary assistance, including Medicare premium assistance, to financially needy patients suffering from a rare genetic disorder (the “Disorder”) violated the Anti-Kickback Statute (“AKS”) or the prohibition on beneficiary […]
On November 21, 2013, the Office of Inspector General (“OIG”) published its Strategic Plan for 2014-2018. The Plan outlines the OIG’s vision for achieving its mission to protect the Department of Health and Human Services (“DHHS”) through a number of goals and priorities. The OIG intends to use the Plan as a guide when determining […]
On November 12, 2013, the Office of Inspector General (the “OIG”) released an unfavorable Advisory Opinion in response to an anesthesiology practice’s (the “Requestor”) inquiry. Specifically, the OIG found that a psychiatry group’s (the “Psychiatry Group”) proposal to pay the Requestor a per-diem rate for anesthesia services while keeping any difference from the amount billed […]
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