Health Law

Published on: April 12, 2013 | by The Health Law Partners

Obama Administration Budget Request for Fiscal Year 2014 Proposal Would Exclude Certain Services from the In-Office Ancillary Services Exception to Stark and Require Prior Authorization for Advanced Imaging Services

On Thursday, April 11, 2013, the Obama Administration released its Budget Request for Fiscal Year 2014 (“FY 2014”) that begins at the beginning of October. If implemented, the Budget Proposal would include approximately $1.8 trillion in savings over the next ten years, enough to replace the automatic sequestration that took effect last month and was […]

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Published on: March 28, 2013 | by The Health Law Partners

CMS Acquiesces to Hospital Pressure, Allows Part B Billing of Hospital Services Following Part A Denial of Inpatient Hospital Claims for Medical Necessity: Is It Enough?

Jessica Gustafson, Esq. and Abby Pendleton, Esq., co-chairs of the firm’s Medicare and RAC department authored an ABA Health eSource article titled “CMS Acquiesces to Hospital Pressure, Allows Part B Billing of Hospital Services Following Part A Denial of Inpatient Hospital Claims for Medical Necessity: Is It Enough?” To view this article click here. Continue […]

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Published on: March 27, 2013 | by The Health Law Partners

HHS Office of Inspector General Issues Special Fraud Alert Regarding Physician Owned Distributorships

On March 26, 2013, the Office of Inspector General (“OIG”) of the United States Department of Health and Human Services (“HHS”) issued a Special Fraud Alert (“SFA”) regarding the potential for Physician-Owned Distributorships (“PODs”) to violate the federal Anti-Kickback Statute (“AKS”). While the OIG has provided guidance previously on the potential for physician-owned entities to […]

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Published on: March 15, 2013 | by The Health Law Partners

CMS Speaks: The Future for Payment of Part B Services Post-RAC Denial – CMS’ Long-Term Solution Too Limiting!

On March 13, 2013, the Centers for Medicare and Medicaid Services (“CMS”) concurrently issued Ruling CMS-1455-NR (the “Ruling”) and a proposed rule for revising Medicare Part B billing policies in the event of Part A payment denials (the “Proposed Rule”). BACKGROUND Since the conclusion of the Recovery Audit Contractor (“RAC”) demonstration program and prior to […]

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Published on: March 12, 2013 | by The Health Law Partners

CMS Updates Manual Regarding Payment for Medical or Surgical Services Furnished by CRNAs

On March 8, 2013, the Centers for Medicare and Medicaid Services (“CMS”) issued Transmittal 2668 (Change Request 8180) to Publication 100-04 (Medicare Claims Processing), rescinding and replacing Transmittal 2634 (January 11, 2013). Transmittal 2634 provided clarifications in the manual language to reflect revisions to 42 C.F.R. § 410.69. The newly-released Transmittal 2668 maintained all changes […]

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Published on: March 12, 2013 | by The Health Law Partners

HHS Slightly Increases Interest Rate on Overpayment Debts/Underpayments Owed Providers

The Department of Health and Human Services (“HHS” or the “Department”) has marginally raised the interest rate on overpayment debts owed to the Department. HHS published notice of the newly certified interest rate for the quarter ended December 31, 2012 in the Federal Register on March 5, 2013. The new rate, 105/8%, represents a ¼% […]

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Published on: March 7, 2013 | by The Health Law Partners

Abby Pendleton, Esq to Speak at The American Academy of Orthopaedic Surgeons Annual Meeting

Abby Pendleton, Esq. will be co-speaking with Jack Bert, M.D. and Ranjan Sachdev, M.D. MBA, CHC on March 19, 2013 at the American Academy of Orthopaedic Surgeons Annual Meeting in Chicago. They will be presenting on the topic “Compliance 2013- What You Need to Know”. Continue Reading →

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Published on: February 26, 2013 | by The Health Law Partners

Highlights From Leon Rodriguez, Executive Director of OCR’s, Speech at ABA’s EMI Conference in Miami

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Published on: February 25, 2013 | by The Health Law Partners

OIG Report Discusses Inadequacy of CMS’ Collection of Medicaid Overpayments

On February 19, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published OIG Report A-05-11-00071 (the “Report”), detailing the results of an audit to determine the adequacy of CMS’ collection of Medicaid overpayments identified in certain OIG audit reports. Under federal regulations (specifically 42 C.F.R. § 433.304), the Secretary […]

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Published on: February 4, 2013 | by The Health Law Partners

Michigan Pharmacist Sentenced to 17 years for Medicare Fraud

On February 1, 2013, 50-year-old Canton pharmacist, BABUBHAI “Bob” PATEL, was sentenced today to 17 years in prison for his 26 convictions for health care fraud conspiracy, drug conspiracy, and related fraud and drug violations. During his 6-week trial which ended in August 2012, Mr. Patel’s pharmacies were found to have billed Medicare, Medicaid and […]

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