On May 18, 2013, the Office of the Inspector General (OIG) of the Department of Health & Human Services issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. This Bulletin replaces the previous version issued in 1999. The Bulletin performs several functions: • Lists prohibited payments. • […]
On May 13, 2013, the American Orthotic and Prosthetic Association (“AOPA”) filed suit in the federal district court for the District of Columbia against the Centers for Medicare and Medicaid (“CMS”), alleging that payment denials by CMS and its Recovery Audit Contractors (“RAC”) are invalid. The lawsuit states that CMS rules call for denial of […]
On April 30, 2013, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced the availability of new tools to educate health care providers and consumers about the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy and Security Rules. Specifically for health care providers, three HIPAA education modules (offering free CME […]
The state of Michigan joined more than two dozen states in passing legislation to permit reporting of unsafe drivers by healthcare providers. Pursuant to Michigan Public Acts 354 and 355 of 2012, signed into law in late December of 2012, physicians and optometrists may now report information regarding a patient’s mental or physical qualifications to […]
The Department of Health and Human Services Office of Inspector General (“OIG”) issued an Updated Provider Self-Disclosure Protocol (“SDP”) on April 17, 2013 which supersedes the original SDP published in 1998 and three later-released open letters that provided additional guidance. The SDP clarifies that it is only available for “all health care providers, suppliers, or […]
On April 25, 2013, the Centers for Medicare and Medicaid (“CMS”) announced the release of additional information for states on implementation of the Affordable Care Act (“ACA”), part of a series of FAQs addressing the subject. The new FAQ provides information on three topics: 1. The availability of the federal match (75%) for maintenance and […]
On Thursday, April 25, 2013, the Centers for Medicare and Medicaid Services announced that it would delay implementing Phase 2 of its Ordering and Referring Physician Claims Editing program due to technical difficulties. CMS has delayed implementing phase 2 of the program before and it is unclear when it will resolve the technical issues. The […]
On Thursday, April 11, 2013, the Obama Administration released its Budget Request for Fiscal Year 2014 (“FY 2014”) that begins at the beginning of October. If implemented, the Budget Proposal would include approximately $1.8 trillion in savings over the next ten years, enough to replace the automatic sequestration that took effect last month and was […]
Jessica Gustafson, Esq. and Abby Pendleton, Esq., co-chairs of the firm’s Medicare and RAC department authored an ABA Health eSource article titled “CMS Acquiesces to Hospital Pressure, Allows Part B Billing of Hospital Services Following Part A Denial of Inpatient Hospital Claims for Medical Necessity: Is It Enough?” To view this article click here. Continue […]
On March 26, 2013, the Office of Inspector General (“OIG”) of the United States Department of Health and Human Services (“HHS”) issued a Special Fraud Alert (“SFA”) regarding the potential for Physician-Owned Distributorships (“PODs”) to violate the federal Anti-Kickback Statute (“AKS”). While the OIG has provided guidance previously on the potential for physician-owned entities to […]
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