The long-awaited final regulations for the Medicare Shared Savings Program (“MSSP”) were released today. The MSSP was implemented by Section 3022 of the Patient Protection and Affordable Care Act and is the program in which ACOs may participate to receive shared savings. In addition to the release of the Final Rule on October 20, the […]
In the Office of Inspector General (“OIG”) Advisory Opinion 11-15, dated October 11, 2011, the OIG analyzes an arrangement in which Requestor is a Delaware Limited Liability Company owned and managed by a physician (the “Owner/Manager”) which would enter into a management contract with an existing or to be formed Medicare-certified clinical anatomic pathology laboratory […]
In an indictment unsealed on October 12, Matthew Kolodesh (a/k/a “Matvei Kolodech”) was charged with a laundry list of crimes, including 1 count of conspiracy to commit healthcare fraud, 21 counts of healthcare fraud, 2 counts of mail fraud and 11 counts of money laundering of monetary instruments over $10,000. Kolodesh set up, controlled and […]
In the Office of Inspector General (“OIG”) Advisory Opinion 11-14, dated October 7, 2011, the OIG analyzes an arrangement in which Requestor is an opthalmic physician group practice that provides cataract surgeries and also employs optometrists. By way of brief background, generally, patients receiving cataract surgery may elect to have either a conventional intraocular lens […]
By way of Transmittal No. 2316 issued on October 7, 2011, CMS clarified the claims processing procedures for hospice services when a required face-to-face encounter does not timely occur. This clarification creates additional administrative burdens to hospice providers when the required face-to-face encounter does not timely occur. Note that the implementation date of the clarified […]
The Centers for Medicare and Medicaid Services (“CMS”), as required by Section 6411 of the Patient Protection and Affordable Care Act (“PPACA”), must annually report to Congress “concerning the effectiveness of the Recovery Audit Contractor program under Medicaid and Medicare and shall include such reports recommendations for expanding or improving the program.” In its FY […]
According to a recent report from the Medical Group Management Association and the Society of Hospital Medicine, hospitalists saw increases in their median compensation in 2010. The report, which is based on survey information from 4,633 hospitalists, found that hospitalists in adult medicine saw their compensation increase 2.6%, while pediatric hospitalists’ pay rose 7.2%. The […]
In a press release issued September 27, 2011, the United States Department of Justice, the Department of Health and Human Services, and the FBI announced that two Miami-area residents pled guilty for their roles in a $25 million home health Medicare fraud scheme. Both defendants pled guilty to conspiracy to commit health care fraud, which […]
Medicare Part A and Part B providers and suppliers appealing Medicare audit decisions at the administrative law judge (“ALJ”) level or through a judicial review must meet an amount in controversy (“AIC”) threshold amount pursuant to regulation at 42 CFR 405.1006(b) and (c). The regulations require the Secretary of the Department of Health and Human […]
As many already know, when a review contractor (e.g., Recovery Audit Contractors (“RACs”), Medicare Administrative Contractors (“MACs”), the Comprehensive Error Rate Testing (“CERT”) contractor, the Program Error Rate Measurement (“PERM”) contractor, and Zone Program Integrity Contractors (“ZPIC”)) identifies an improper payment, the review contractor requests medical documentation from the provider or supplier to ensure the […]
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