Health Law

Published on: March 28, 2012 | by The Health Law Partners

OIG Views Favorably a Proposal to Operate Website Containing Coupons and Advertising from Health Care Entities

On March 27, 2012, the Office of Inspector General (“OIG”) posted a favorable, but narrowly defined, Advisory Opinion (Opinion No. 12-02) pertaining to Requestor’s proposal to operate a website that would display coupons and advertising from health care providers, suppliers, and other entities (the “Proposed Arrangement”). Under the Proposed Arrangement, the Requestor, a corporation with […]

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Published on: March 19, 2012 | by The Health Law Partners

Michigan Man Charged with Health Care Fraud in NY

According to a Department of Justice press release, on Thursday March 15, 2012, a man residing in Dearborn Heights, Michigan was charged by Criminal Complaint with health care fraud. 51-year-old Fitzgerald Anthony Hudson was arrested, and could face a maximum penalty of 10 years imprisonment and a fine of $250,000. Assistant U.S. Attorney Aaron J. […]

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Published on: March 19, 2012 | by The Health Law Partners

OIG Report Questions IDTF Billings

In a Study released March 15, 2012, the Department of Health and Human Services, Office of Inspector General (OIG), reported on what it determined to be questionable billing by Independent Diagnostic Testing Facilities (IDTFs) for claims submitted in 2009. In conducting this study, the OIG analyzed claims among geographic areas, identified as Core Based Statistical […]

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Published on: March 16, 2012 | by The Health Law Partners

RAC Program (Medicare Fee-for-Service) Record Request Limits Increased

Medicare released new guidelines regarding the limit on the number of additional documentation requests (“ADRs”) RACs may request per 45-day period. Notably, these revisions constitute an increase for providers. (Note: the revised ADR limits outlined below do not apply to physicians and suppliers.) Effective March 15, 2012, the ADR limits will follow the guidelines bulleted […]

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Published on: March 16, 2012 | by The Health Law Partners

Medicare Redesigns Claims and Benefits Statement to Empower Seniors with Clearer Information on Health Services Used

The Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The announcement comes as a part of National Consumer Protection Week. The redesigned statement, known as the Medicare Summary Notice (MSN), will be […]

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Published on: March 2, 2012 | by The Health Law Partners

Highmark Medicare Services Now Novitas Solutions

Effective January 1, 2012, Highmark Medicare Services (“Highmark”) was acquired by Diversified Service Options, Inc. (a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc.). As a result of the acquisition, Highmark changed its name to Novitas Solutions, Inc. (“Novitas”). Novitas will continue Highmark’s role as the Medicare Administrative Contractor (“MAC”) for J12 […]

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Published on: February 24, 2012 | by The Health Law Partners

CMS Releases Email Alert Regarding Advanced Diagnostic Imaging Accreditation

On February 23, 2012, CMS issued an email notification to all Fee-for-Service (“FFS”) providers, which states the following: CMS has received reports that providers are receiving denials for advanced diagnostic imaging (ADI) services they are accredited to perform. We have taken action to correct the situation. CMS has instructed all contractors to review each ADI […]

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Published on: February 21, 2012 | by The Health Law Partners

CMS Revises Interpretative Guidelines for Rehabilitation in Outpatient Hospitals

In response to concerns raised by the American Physical Therapy Association (APTA) and other associations, the Centers for Medicare and Medicaid Services (CMS) has revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges. The new guidance issued to […]

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Published on: February 20, 2012 | by The Health Law Partners

CMS Issues Proposed Rule on Reporting and Refunding Medicare Overpayments

Section 6402(a) of the Patient Protection and Affordable Care Act (PPACA) established a new section in the Social Security Act mandating that providers timely report and return Medicare overpayments. Since PPACA’s passage, the healthcare community has awaited clarification on several ambiguities contained in the statute. On February 16, 2012, CMS released a proposed rule implementing […]

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Published on: February 13, 2012 | by The Health Law Partners

Did CVS Go Too Far?

As we reported in a previous blog entry, HHS recently encouraged prescription drug plans to delay the payment of suspicious claims and to take proactive measures to prevent prescription drug fraud such as requiring pre-authorizations and limiting payment of controlled substances beyond a thirty-day supply . Now, it seems that CVS has decided to take […]

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