In Advisory Opinion 12-15, issued October 23, the Office of Inspector General (“OIG”) approved a Hospital’s plan to pay specialists on a per diem basis to provide on-call coverage in its Emergency Department (“ED”). Requestor, a tax-exempt, charitable, not-for profit hospital had struggled to fill shortages in its ED for on-call coverage. To meet the […]
Compounding pharmacies have seen increased government investigations in recent years, and are likely to face heightened scrutiny from state and/or federal authorities in the near future. Coupled with heightened scrutiny of health care providers in general, compounding pharmacies should carefully review their operations for compliance with law. Incidents involving providers of compounded medications, most notably […]
Abby Pendleton, Esq. of The HLP was quoted in “Hospitals Brace for Audits of Short-Stay Admissions”, published November 5, 2012 in Crain’s Detroit Business on-line regarding RAC audit activity. In particular, the story discussed the new Medicare RAC pre-payment program and its impact on short-stay hospital admissions. Pendleton was interviewed for the Crain’s story and […]
On October 31, 2012, the United States Government Accountability Office (GAO) released a study detailing the results of a six-year analysis they had conducted regarding self-referral practices of physicians and group practices that own/lease/operate magnetic resonance imaging (MRI) and computed tomography (CT) services. Self-referrals for MRI/CT services are often excepted from the reach of the […]
The American Hospital Association (“AHA”) and four hospitals (collectively, the “Plaintiffs”) have filed a lawsuit against the Department of Health and Human Services (“HHS”), alleging that the Centers for Medicare and Medicaid Services (“CMS”, a sub-agency of HHS), through its Medicare RAC Program, has inappropriately refused to pay for Medicare Part B services that it […]
On October 11, 2012, The OIG distributed a questionnaire to hospitals that have received Medicare EHR incentive payments for demonstrating meaningful use of its certified EHR technology. This questionnaire is being sent to hospitals that have received incentive payments between January 1, 2011 and March 31, 2012 which amounts to approximately 830 hospitals nationwide. The […]
On October 18, 2012, the Michigan Department of Licensing and Regulatory Affairs (“LARA”) announced that it will be combining the current Bureau of Health Professions (“BHP”),which governs individual licensed and registered health care providers such as physicians and nurses, and the Bureau of Health Systems (“BHS”), which governs licensed health care entities such as hospitals […]
On October 3, 2012, New York State Governor Andrew Cuomo acted on several health care related bills, including legislation dealing with accountable care organizations and patient referral laws. The Governor approved by signing into law an act to amend the Public Health Law in relation to accountable care organizations (ACOs) (A.8869-B/S.6228-B), which is intended to […]
On October 5, the Office of Inspector General (“OIG”) issued Advisory Opinion 12-13, approving a proposed arrangement allowing a hearing aid supplier to bill Medicare for certain audiometric testing services, while also offering a free hearing exam to potential patients (“Proposed Arrangement”). The requestor owned a chain of hearing aid supply and service locations which […]
On September 28, CMS issued Transmittal 2156 revising and clarifying Place of Service Coding (POS) instructions. The Transmittal rescinds previous Transmittal 2435, extends the implementation date to April 1, 2013 and provides a few clarifications for physicians and other supplier entities when determining the appropriate Point of Service (POS) designation for Physicians and Supplier entities. […]
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