Kevin Clinton, the Michigan Insurance Commissioner, issued an order on July 18, 2012 that bans insurance companies from enforcing most favored nation clauses in health insurance contracts unless they are first submitted to him for approval. The order is effective February 1, 2013. As defined by the order, a most favored nation clause is one […]
MEDICARE APPROVES 89 NEW ACOs WHILE NEW YORK STATE AND PRIVATE PAYERS CONTINUE TO ADOPT ACO-RELATED STRATEGIES –Federal Government On July 9th, the U.S. Department of Health and Human Services added 89 new accountable care organizations to its list of entities which have been approved to participate in the Medicare Shared Savings Program. Nine of […]
Proposed changes to policies and payment rates for services paid under the Medicare Physician Fee Schedule (MPFS) for 2013 were released on July 6. The Centers for Medicare & Medicaid Services (CMS) released the proposed rules and the public is free to comment on the changes throughout a 60-day period that ends September 4, 2012. […]
On June 13, 2012, the California Supreme Court unanimously denied review in the case of California Society of Anesthesiologists v. Superior Court, 204 Cal.App.4th 390 (1st Dist. 2012) ending an over two year battle by the California Society of Anesthesiologists and the California Medical Association who challenged former governor Arnold Schwarzenegger’s certification to the federal […]
In the recently released Federal Register, The Office of Inspector General (OIG) informed the public that that it intends to update the Provider Self-Disclosure Protocol (the Protocol) and is soliciting input. The Protocol, which was first introduced in 1998, is the process that health care providers can take in order to disclose potential fraud involving […]
Recently, CMS released a related change request (CR) 7838, which informs Medicare contractors about a new addition to the “Medicare Benefit Policy Manual,” Chapter 9, Section 90, which is titled, “Caps and Limitations on Hospice Payment.” A summary of the key provisions of the new Chapter 9, Section 90 of the “Medicare Benefit Policy Manual,” […]
The Government Accountability Office (“GAO”) recently released a Report on the National Medicaid Audit Program (“NMAP”), which found that “private contractors received $102 million to review Medicaid fraud data, yet had only found about $20 million in overpayments since 2008.” In summary, the Report found that compared with initial test audits and more recent collaborative […]
On June 1, 2012, the Department of Health and Human Services Office of Inspector General (the “OIG”) issued its Advisory Opinion No. 12-06, which provides long-awaited guidance to the health care industry regarding the legal permissibility of an anesthesia delivery service model commonly referred to as the “company model.” Insofar as Advisory Opinion No. 12-06 […]
In their June newsletter, The Record, Blue Cross Blue Shield of Michigan (BCBSM) recommended that physicians “consult with their legal counsel periodically.” The problem that BCBSM identified is the situation where physicians prescribe and dispense durable medical equipment and prosthetics and orthotics items in order to provide a means for their patients to be ambulatory […]
On May 18, 2012, Medicare released their 2nd Quarter Newsletter regarding the recovery efforts of each of the region’s Recovery Audit Contractors: DCS, CGI, Connolly, and HDI. CGI Federal has the lowest level of overpayment recoupments and underpayment identification. Connolly and HDI/HMS are identifying and correcting exceedingly more improper payments compared to CGI and DCS. […]
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