Health Law Attorney Blog

Published on: February 14, 2012 | by The Health Law Partners

CMS Releases Details of Fee-for-Service Recovery Audit Prepayment Review Demonstration and Prior Authorization Demonstration

On February 7, 2012, The Centers for Medicare and Medicaid Services (CMS) released a Request for Comments regarding two demonstration programs it intends to conduct. The first, the Recovery Audit Prepayment Review Demonstration, will allow CMS and its agents to request additional documentation, including medical records, to support submitted claims. In Chapter 3 of the […]

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Published on: February 13, 2012 | by The Health Law Partners

Did CVS Go Too Far?

As we reported in a previous blog entry, HHS recently encouraged prescription drug plans to delay the payment of suspicious claims and to take proactive measures to prevent prescription drug fraud such as requiring pre-authorizations and limiting payment of controlled substances beyond a thirty-day supply . Now, it seems that CVS has decided to take […]

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Published on: February 10, 2012 | by The Health Law Partners

OIG Alerts Physicians to Exercise Caution When Reassigning Their Medicare Payments

OIG recently issued an alert for physicians who reassign their right to bill the Medicare program and receive Medicare payments by executing the CMS-855R application, which says they may be liable for false claims submitted by entities to which they have reassigned their Medicare benefits. OIG has advised physicians to use increased scrutiny of entities […]

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Published on: February 8, 2012 | by The Health Law Partners

RAC Audits: OIG Releases Recovery Act Oversight Monthly Reports

On February 8, 2012, the Office of Inspector General published the November and December Recovery Act Oversight Monthly Reports. The most recent figures indicate that in November 2011, $12,589,859.00 dollars of Recovery Act funds were used on Recovery Audit activities. In December 2011, $13,161,164.00 dollars of Recovery Act funds were used on Recovery Audit activities. […]

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Published on: February 1, 2012 | by The Health Law Partners

BREAKING NEWS: The HLP Welcomes New Attorneys and Opens Office in Lake Success, NY

BREAKING NEWS: The HLP Welcomes New Attorneys and Opens Office in Lake Success, NY The Health Law Partners proudly announces that a group of prominent attorneys, widely considered among the top-tier of health care lawyers in NY, are joining our firm effective February 1. In addition to our Southfield, MI, Atlanta, GA and Manhattan offices, […]

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Published on: January 18, 2012 | by The Health Law Partners

OIG Issues “Compliance Program Basics” HEAT Provider Compliance Training Video

Recently the OIG released the 7th of 11 videos that cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises. The videos are from the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. Compliance Programs, simply […]

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Published on: January 16, 2012 | by The Health Law Partners

Inpatient Admission v. Outpatient Observation

When a patient presents at an emergency department of a hospital, they are evaluated by a ER physician to determine whether they should be admitted as inpatient or outpatient observation. An inpatient admission occurs when a person is admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services. The criteria when […]

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Published on: January 6, 2012 | by The Health Law Partners

CMS Halts Anti-Fraud Projects Among Heavy Provider Opposition

Modern Healthcare reports that two anti-fraud demonstration projects announced in November by CMS were delayed after they drew heavy provider opposition. The first project would require pre-authorization for scooters and power wheelchairs prescribed to Medicare beneficiaries in any of the seven states with the highest concentration of fraud or billing errors, including, California, Michigan, New […]

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Published on: January 5, 2012 | by The Health Law Partners

DME RAC Contingency Fee Up 5% to 17.5%

On December 30, 2011, CMS issued an informational bulletin CPI-B 12-01 entitled, Affordable Care Act Program integrity Provisions – Guidance to States – Section 6411(a) – Expansion of the Recovery Audit Contractor (RAC) Program to Medicaid (“Bulletin”). By way of brief background, Section 6411(a) of the Patient Protection and Affordable Care Act (“PPACA”) expands the […]

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Published on: January 4, 2012 | by The Health Law Partners

AseraCare Hospice Sued by U.S. Over Alleged False Claims Act Violations

Hospice provider AseraCare is accused of submitting “false and fraudulent” Medicare claims for payment to the U.S. It has been alleged that the hospice has been claiming charges to the Federal Government for those patients who were not admitted to hospice. Hospice care is provided to Medicare recipients who have a prognosis of six months […]

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