On May 22, 2009, CMS published changes to the Medicare Benefit Policy Manual and Medicare Claims Processing Manual related to outpatient observation. The changes are set forth in Transmittal 1745 and will become effective July 1, 2009. The changes delete references to “admission” and “observation status” in relation to outpatient observation services. CMS acknowledged that […]
According to its most-recently published “Expansion Schedule,” the Centers for Medicare and Medicaid Services (CMS) planned to expand the Recovery Audit Contractor (RAC) program to 23 states by March 1, 2009, and the remaining states by August 1, 2009 or later. RAC automated reviews soon will begin, but medical necessity reviews have been delayed. On […]
Health Law Partners Adrienne Dresevic and Carey F. Kalmowitz published an article in Link, the American Healthcare Radiology Administrators (AHRA) member newsletter, which discusses current application of the Federal Stark law. The article addresses the In-Office Ancillary Services Exception (IOASE), which many office-based diagnostic imaging arrangements rely upon to enable referring physicians to provide ancillary […]
Over 250,000 Americans fall victim to medical identity theft each year, according to an article by the New York Times, and the increased use of electronic medical records with less than adequate privacy protection has allowed this number to rise. Medical identity theft is easily carried out when thieves attain someone’s name and Social Security […]
Today, President Obama plans to address the American Medical Association (AMA) to discuss his future plans regarding healthcare. His plans intend to make the healthcare industry in the United States–one that represents roughly 18% of the U.S. economy–more efficient through a government-sponsored insurance plan while not adding to the federal deficit. This government-sponsored insurance plan […]
Florida gives physicians the green light to be paid. On June 10, Governor Crist, of Florida, signed a bill that will allow insurance companies to pay out-of-network physicians directly, if the patient allows. Prior to this law, out-of-network physicians prayed that they would receive their claims payment from patients who received it from the insurance […]
On June 11, 2009, the Substantive Law Committee of the Health Care Law Section of the Michigan State Bar held a teleconference on the recent Michigan Medical Marihuana Act. Included amongst the presenters was Melanie Brim, the current Director of the Bureau of Health Professions at the Michigan Department of Community Health. Ms. Brim indicated […]
The OIG excludes almost 1,500 individuals and entities for fraud and abuse-related crimes. In its most recent Semiannual Report to Congress for October 1, 2008 to March 31, 2009, the OIG includes in its summary of accomplishments “exclusions of 1,415 individuals and entities for fraud or abuse involving Federal health care programs and/or their beneficiaries” […]
Michigan Medicaid enrollment is increasing, due to the challenging economic status of the state, says the Detroit News. However, also due to the state’s economy, Medicaid is cutting reimbursement payments to physicians, causing many of them to turn down new or even all Medicaid patients. According to physicians, the reimbursements they receive from Medicaid, even […]
Liability under the Civil False Claims Act has been expanded. On May 20, 2009, President Obama signed the Fraud Enforcement and Recovery Act (FERA) into law. FERA contains amendments to the civil False Claims Act (FCA) that expand liability under FCA and gives the government increased powers to investigate. According to FERA, an entity violates […]
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