On June 23, 2011, the Departments of Justice and Health and Human Services announced that, under the aegis of the inter-agency Health Care Fraud Prevention and Enforcement Action Team (HEAT) program, three employees of the Solstice Wellness Center, a Brooklyn-area clinic that purported to specialize in providing physical therapy and diagnostic tests, have pleaded guilty […]
By correcting vulnerabilities identified by Recovery Audit Contractors (“RACs”) and similar Medicare contractors, the Centers for Medicare and Medicaid Services (“CMS”) hopes to reduce the rate of mistakes uncovered by the Comprehensive Error Rate Testing (“CERT”) program. Diagnosis Related Group (“DRG”) Validation review is one of the processes RACs utilize to review Medicare claims submitted […]
On June 29, 2011, the 6th Circuit Court of Appeals upheld a lower court’s ruling on the health reform law’s requirement that nearly all Americans buy insurance. The three-judge panel, including two Republican nominees, ruled 2-1 in favor of the mandate. The original suit was brought by the Thomas More Law Center, which argued that […]
A shortage of primary care doctors has long concerned health policy experts, and the deficiency could grow even more severe if health insurance coverage is extended to more than 30 million Americans as expected under the new health care law. In response to the issue, the Obama administration began recruiting individuals to become “mystery shoppers” […]
The 2012 Michigan state budget, signed into law by Governor Rick Snyder on June 21, 2011, assumes the passage of the Health Insurance Claims Assessment Act. The proposed law involves a new 1 percent tax on paid health care claims and was introduced by the legislature as Senate Bill No. 348. The potential tax would […]
On June 21, 2011, the Departments of Justice and Health and Human Services (“HHS”) announced that Maria Haber, an owner of a medical clinic based in Metro Detroit, was sentenced for her involvement in a $1.12 million Medicare fraud scheme. Haber’s penalty includes 15 months in prison, 3 years of supervised release, and over $1 […]
On June 17, 2011, the Centers for Medicare & Medicaid Services (“CMS”) announced that beginning July 1, 2011 it will start to utilize an innovative predictive modeling technology to aid the prevention of Medicare fraud. This CMS announcement comes in the wake of Obama’s Campaign to Cut Waste launch. The predictive modeling technology should help […]
Large commercial companies have never fared well when offering kickbacks to physicians. Historically, regulators have aggressively pursued such wrongdoers for their attempts to interfere with sound medical judgment. Physicians, on the other hand, have often gone unprosecuted for their involvement in kickback schemes. However, according to the general counsel to the Department of Health and […]
On June 21, 2011, the Office of Inspector General of the U.S. Department of Health and Human Services (“OIG”) posted Advisory Opinion No. 11-08. This Opinion addresses possible federal Anti-Kickback Statute sanctions for payments made by a Medicare DME Supplier to a Medicare sleep test provider for storing the Supplier’s PAP equipment and supplies and […]
MedPAC released its highly anticipated proposal calling for a reduction in the use of imaging services, including MRIs, CT scans and nuclear medicine, and, in particular, recommended pre-authorization for medical imaging services as a means to accomplish this objective. The MedPAC report focuses, in particular, on physicians who order an inordinately high volume of imaging […]
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