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 […]
On March 13, 2013, the Centers for Medicare and Medicaid Services (“CMS”) concurrently issued Ruling CMS-1455-NR (the “Ruling”) and a proposed rule for revising Medicare Part B billing policies in the event of Part A payment denials (the “Proposed Rule”). BACKGROUND Since the conclusion of the Recovery Audit Contractor (“RAC”) demonstration program and prior to […]
On March 8, 2013, the Centers for Medicare and Medicaid Services (“CMS”) issued Transmittal 2668 (Change Request 8180) to Publication 100-04 (Medicare Claims Processing), rescinding and replacing Transmittal 2634 (January 11, 2013). Transmittal 2634 provided clarifications in the manual language to reflect revisions to 42 C.F.R. § 410.69. The newly-released Transmittal 2668 maintained all changes […]
The Department of Health and Human Services (“HHS” or the “Department”) has marginally raised the interest rate on overpayment debts owed to the Department. HHS published notice of the newly certified interest rate for the quarter ended December 31, 2012 in the Federal Register on March 5, 2013. The new rate, 105/8%, represents a ¼% […]
Abby Pendleton, Esq. will be co-speaking with Jack Bert, M.D. and Ranjan Sachdev, M.D. MBA, CHC on March 19, 2013 at the American Academy of Orthopaedic Surgeons Annual Meeting in Chicago. They will be presenting on the topic “Compliance 2013- What You Need to Know”. Continue Reading →
To view this article, please click here. Continue Reading →
On February 19, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published OIG Report A-05-11-00071 (the “Report”), detailing the results of an audit to determine the adequacy of CMS’ collection of Medicaid overpayments identified in certain OIG audit reports. Under federal regulations (specifically 42 C.F.R. § 433.304), the Secretary […]
On February 1, 2013, 50-year-old Canton pharmacist, BABUBHAI “Bob” PATEL, was sentenced today to 17 years in prison for his 26 convictions for health care fraud conspiracy, drug conspiracy, and related fraud and drug violations. During his 6-week trial which ended in August 2012, Mr. Patel’s pharmacies were found to have billed Medicare, Medicaid and […]
On January 24, 2013, the U.S. Attorney’s Office for the State of New Jersey unsealed a $12.5 Million Dollar settlement with Cooper Health System, headquartered in the Camden, New Jersey area, but serving regions of New Jersey, Pennsylvania and Delaware. The settlement was the result of cardiologist Nicholas DePace’s whistleblower qui tam lawsuit, which alleged […]
On January 15, 2013, Richard Behnan, DPM., a 56 year old podiatrist from Fenton, MI was sentenced by a federal judge to 55 months in prison and ordered to pay over $1.4 million in restitution to Medicare and nearly $200,000 to BCBSM for his participation in a $1.6 million fraudulent medical billing scheme. Dr.Behnan previously […]
Health Law Attorney Blog