In recent years, the Centers for Medicare & Medicaid Services (“CMS”) has taken steps to address potentially undervalued and overvalued services under the Medicare Physician Fee Schedule. In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012, CMS specifically addresses payment codes for bone density tests. Since the payment calculation specified by […]
In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012, the Centers for Medicare & Medicaid Services (“CMS”) proposes the addition of new codes to the list of Medicare telehealth services. After reviewing numerous submitted requests, CMS only proposes the addition of smoking cessation services as approved Medicare telehealth services for CY […]
The most recent advisory opinion released by the Centers for Medicare & Medicaid Services (“CMS”), Advisory Opinion No. CMS-AO-2011-01, analyzes the acceptability of a non-competition clause in a proposed physician agreement (“Proposed Agreement”) in light of the Stark Physician Recruitment Exception (42 C.F.R. 411.357(e)). Specifically, the Requestor (or “the Hospital”) inquires whether the Proposed Agreement […]
Section 105 of the Medicare and Medicaid Extenders Act of 2010 (“MMEA”) extended the payment to independent laboratories for the technical component (“TC”) of certain physician pathology services through calendar year (“CY”) 2011 only. In line with section 105, the Centers for Medicare & Medicaid Services’ (“CMS”) Proposed Physician Fee Schedule for CY 2012 revises […]
The Department of Justice announced on June 30, 2011 that a Las Vegas physician, Rakesh Nathu, settled False Claims Act allegations with the United States for $5.7 million plus interest. Nathu allegedly submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Plan for various radiation oncology services from 2007 to 2009. Allegations […]
Prior to the passing of section 102(a)(1) of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (“PACMBPRA”), the 3-day payment window policy for nondiagnostic services provided prior to admission was rarely applied to wholly owned or operated physician practices. However, the enactment of section 102(a)(1) widened the range […]
On June 30, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule which eliminates the requirement that physicians and non-physician practitioners must sign requisition forms for clinical diagnostic laboratory tests. The original policy was established by the final 2011 Medicare Physician Fee Schedule, but it was placed on hold earlier this […]
Federal law enforcement officials announced on June 29, 2011 that Jacinto “John” Gabriel, Jr., a Chicago man responsible for operating two home health care businesses, was indicted in an alleged $20 million Medicare fraud scheme spanning five years. The 15-count indictment includes health care fraud, wire fraud, and money laundering. According to court documents, Gabriel […]
The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule regarding the 2012 Medicare Physician Fee Schedule on July 1, 2011 (“Proposed Rule”). Among the potential changes found in the Proposed Rule is a 50 percent discount to the professional component (“PC”) of subsequent MRI, CT, and ultrasound procedures. This proposed change mirrors […]
The Senate Finance Committee abandoned the proposed increase to the Medicare utilization rate assumption for advanced diagnostic imagining equipment priced at $1 million or more. The potential rate hike was included as a provision in a proposed free trade agreement and was meant to pay for health care benefits and job training for U.S. workers […]
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