Health Law

Published on: June 30, 2011 | by The Health Law Partners

RAC DRG Coding Vulnerabilities Identified, Guidance for Inpatient Hospitals Addressed by New CMS Article

By correcting vulnerabilities identified by Recovery Audit Contractors (“RACs”) and similar Medicare contractors, the Centers for Medicare and Medicaid Services (“CMS”) hopes to reduce the rate of mistakes uncovered by the Comprehensive Error Rate Testing (“CERT”) program. Diagnosis Related Group (“DRG”) Validation review is one of the processes RACs utilize to review Medicare claims submitted […]

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Published on: June 30, 2011 | by The Health Law Partners

6th Circuit Court of Appeals Panel Upholds the Health Reform Law’s Individual Mandate

On June 29, 2011, the 6th Circuit Court of Appeals upheld a lower court’s ruling on the health reform law’s requirement that nearly all Americans buy insurance. The three-judge panel, including two Republican nominees, ruled 2-1 in favor of the mandate. The original suit was brought by the Thomas More Law Center, which argued that […]

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Published on: June 29, 2011 | by The Health Law Partners

Administration Places Health “Mystery Shopper” Initiative on Hold

A shortage of primary care doctors has long concerned health policy experts, and the deficiency could grow even more severe if health insurance coverage is extended to more than 30 million Americans as expected under the new health care law. In response to the issue, the Obama administration began recruiting individuals to become “mystery shoppers” […]

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Published on: June 28, 2011 | by The Health Law Partners

Michigan Health Claims Tax Proposed, Relied On in State Budget

The 2012 Michigan state budget, signed into law by Governor Rick Snyder on June 21, 2011, assumes the passage of the Health Insurance Claims Assessment Act. The proposed law involves a new 1 percent tax on paid health care claims and was introduced by the legislature as Senate Bill No. 348. The potential tax would […]

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Published on: June 27, 2011 | by The Health Law Partners

Another Medicare Defrauder Sentenced in Metro Detroit

On June 21, 2011, the Departments of Justice and Health and Human Services (“HHS”) announced that Maria Haber, an owner of a medical clinic based in Metro Detroit, was sentenced for her involvement in a $1.12 million Medicare fraud scheme. Haber’s penalty includes 15 months in prison, 3 years of supervised release, and over $1 […]

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Published on: June 24, 2011 | by The Health Law Partners

Predictive Modeling Technology to Assist CMS in Detecting Medicare Fraud

On June 17, 2011, the Centers for Medicare & Medicaid Services (“CMS”) announced that beginning July 1, 2011 it will start to utilize an innovative predictive modeling technology to aid the prevention of Medicare fraud. This CMS announcement comes in the wake of Obama’s Campaign to Cut Waste launch. The predictive modeling technology should help […]

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Published on: June 23, 2011 | by The Health Law Partners

Regulators Toughen Up on Doctors

Large commercial companies have never fared well when offering kickbacks to physicians. Historically, regulators have aggressively pursued such wrongdoers for their attempts to interfere with sound medical judgment. Physicians, on the other hand, have often gone unprosecuted for their involvement in kickback schemes. However, according to the general counsel to the Department of Health and […]

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Published on: June 22, 2011 | by The Health Law Partners

OIG Addresses CPAP Set-Up Service Arrangements between a DME Supplier and a Sleep Test Provider under the Federal Anti-Kickback Law

On June 21, 2011, the Office of Inspector General of the U.S. Department of Health and Human Services (“OIG”) posted Advisory Opinion No. 11-08. This Opinion addresses possible federal Anti-Kickback Statute sanctions for payments made by a Medicare DME Supplier to a Medicare sleep test provider for storing the Supplier’s PAP equipment and supplies and […]

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Published on: June 21, 2011 | by The Health Law Partners

MedPAC Proposes Prior-Authorization Program

MedPAC released its highly anticipated proposal calling for a reduction in the use of imaging services, including MRIs, CT scans and nuclear medicine, and, in particular, recommended pre-authorization for medical imaging services as a means to accomplish this objective. The MedPAC report focuses, in particular, on physicians who order an inordinately high volume of imaging […]

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Published on: June 16, 2011 | by The Health Law Partners

Responding to RAC ADRs

In reviewing certain inpatient hospital claims, the RAC for Region B (covering the Midwestern states), CGI, and its subcontractor, PRG Schultz, are now requesting that nursing notes not be included in response to additional documentation requests (“ADRs”). Note that this directive is not consistent across all ADRs, as other ADRs specifically ask for nursing records. […]

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