It is customary for insurers to deny claims submitted by no-fault providers, and providers, in turn, commonly challenge these denials. Conversely, it is anomalous for a no-fault provider to initiate a (putative) class action suit in response to an insurer’s payment denials. Yet, in a recently filed action, an aggrieved provider did just that. Pan […]
The Centers for Medicare & Medicaid Services (“CMS”) announced changes to the Medicare Fee-For-Service Recovery Audit Program in a posting on the CMS.gov website February 18, 2014. According to CMS, the changes will go into effect after the new Recovery Audit Program contracts are awarded. The announcement includes changes to the contingency fees paid to […]
Federal authorities are cracking down on abuse of the HITECH Act’s Meaningful Use financial incentive program as evidenced by the recent indictment of Joe White, former CEO of Shelby Regional Medical Center (“Shelby Regional”) in Tyler, Texas. A federal grand jury indicted White on charges of making false statements to the Centers for Medicare and […]
On January 16, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced that it will release a national provider Comparative Billing Report (“CBR”) addressing Positive Airway Pressure (“PAP”) Devices and Accessories. CMS is using CBRs as a tool to educate providers about applicable Medicare billing rules in furtherance of its goal to improve the […]
The U.S. Justice Department’s Medicare Fraud Strike Force set record numbers for health care prosecutions throughout the Country in Fiscal Year (FY) 2013. The Medicare Fraud Strike Force is a coordinated team of investigators and prosecutors from the Justice Department, the U.S. Department of Health and Human Services and the FBI who, under the supervision […]
An article in Hospitals & Health Networks (“H&HN”), the flagship publication of the American Hospital Association, quoted HLP attorneys Abby Pendleton and Jessica Gustafson on the effects of Medicare audits on hospitals. The article, published on January 14, 2014, discusses the overwhelming burden on hospitals created by the Medicare audit program and recovery audit contractors […]
February 28, 2014 marks the deadline for eligible professionals (“EPs”) to register and attest to demonstrating meaningful use for the 2013 Medicare Electronic Health Records (“EHR”) Incentive Program. EPs must successfully attest by 11:59 pm ET on February 28 to receive incentive payment for 2013 participation. The Medicare EHR Incentive Program provides incentive payments to […]
In a memorandum to Office of Medicare Hearings and Appeals (“OMHA”) applicants, the Centers for Medicare and Medicaid Services (“CMS”) announced that it will temporarily suspend the assignment of new requests for Administrative Law Judge (“ALJ”) hearings for two years. CMS stated in the memo that the reason for the temporary suspension is the increasing […]
On December 26, 2013, the Department of Health and Human Services (“HHS”) and Adult & Pediatric Dermatology, P.C. (“APDerm”) agreed to settle potential violations of the HIPAA Privacy, Security, and Breach Notification Rules for $150,000. In addition the $150,00 settlement, APDerm will also be required to implement a corrective action plan to correct deficiencies in […]
On January 14, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced a new policy regarding requests made under the Freedom of Information Act (“FOIA”) on amounts paid to individual physicians under the Medicare program. This notice reverses more than 30 years of prior policy. CMS will now make case-by-case determinations as to whether […]
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