Joan Polacheck

Joan Polacheck

McDermott Will & Emery

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CMS Proposes Stark Law Amendments, Requests Comments on Whether Stark Law Is Barrier to Health Care Reform

On July 8, 2015, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking to amend its regulations implementing and interpreting the Stark Law (the Proposed Rule). 80 Fed. Reg. 41,686,...more

7/28/2015 - CMS Comment Period FQHC Healthcare Healthcare Providers Healthcare Reform Medicaid Medicare Nurse Practitioners Patient Referrals Physician Compensation Arrangements Physician-Owned Hospitals Physicians Proposed Regulation Rural Health Care Providers Stark Law

CMS Addresses Current Position on Supervision and Practitioner Qualifications Under ‘Incident-To’ Billing Rules

Among the proposed changes to Medicare regulatory requirements related to billing and coverage of physician services set forth in the 2016 Medicare Physician Fee Schedule Proposed Rule (the Proposed Rule), the Centers for...more

7/21/2015 - CMS Healthcare Professionals Healthcare Providers Medicaid Medicare Nurse Practitioners OIG Physician Fee Schedule Physicians Proposed Regulation Stark Law Supervision

CMS Proposal Broadens Medicare Inpatient Reimbursement Eligibility Under the “2-Midnight Rule"

On July 1, 2015, the Centers for Medicare & Medicaid Services (CMS) released proposed updates to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for Calendar Year...more

7/8/2015 - Ambulatory Surgery Centers CMS Health Care Providers Healthcare Professionals Hospitals Inpatient Billing Medicaid Medicare Medicare Administrative Contractors (MAC) Medicare Part A OPPS Physicians Proposed Regulation Recovery Audit Contractor Two-Midnight Rule

Recent DOJ and OIG Actions Show Growing Federal Scrutiny of Physician Financial Arrangements

Over the last month the Office of Inspector General (OIG) of the Department of Health and Human Services and the Department of Justice (DOJ) have each taken actions that suggest an increasing appetite to examine the financial...more

7/2/2015 - Anti-Kickback Statute CMP Law DOJ False Claims Act Fraud Alerts Healthcare Medical Directors OIG Physician Compensation Arrangements Physicians Stark Law

SGR Legislation Includes Gainsharing Fix and More Anti-Fraud Measures

The legislation repealing the Medicare sustainable growth rate formula (SGR), signed by President Obama on April 16, 2015, contained several anti-fraud related provisions that affect the health care industry. The provision...more

4/27/2015 - Amended Legislation CMP Law Gainsharing Hospitals Medicare OIG Physician SGR Formula Physicians

CMS Finalizes Proposal to Remove Continuing Medical Education Exclusion from Sunshine Act Regulations

On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its final Medicare physician fee schedule rule for CY 2015 (the Final Rule), which also includes certain changes to the Sunshine Regulations. ...more

11/13/2014 - CMS Continuing Medical Education Final Rules Medicare Pharmaceutical Pharmaceutical Manufacturers Physician Fee Schedule Physicians Sunshine Act

OIG Proposes Expanding Anti-Kickback Statute Safe Harbors and Revising Civil Monetary Penalty Regulations

On October 2, 2014, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) published a proposed rule containing revisions to both the Anti-Kickback Statute (AKS) safe harbors and the civil...more

10/8/2014 - Affordable Care Act Anti-Kickback Statute Civil Monetary Penalty Cost-Sharing Healthcare Medicare Part D OIG Pharmacies Proposed Regulation Safe Harbors Waivers

CMS Proposes Removing CME Exclusion from Sunshine Act Regulations, Citing Redundancy with Indirect Payment Exclusion

In the July 3, 2014, issue of the Federal Register, The Centers for Medicare & Medicaid Services (CMS) published the proposed calendar year 2015 Medicare physician fee schedule update (the Proposed Rule). The Proposed Rule...more

8/8/2014 - Affordable Care Act CMS Continuing Medical Education Medicare Physician Medicare Reimbursements Proposed Regulation Sunshine Act

OIG Proposes Rule to Expand Civil Monetary Penalties and Solicit Comments on Penalty for Failure to Report and Return Overpayments...

Department of Health and Human Services, Office of Inspector General’s (OIG) proposed rule expands the use of civil monetary penalties and solicits comments on the penalty for failure to report and return overpayments. ...more

5/29/2014 - Civil Monetary Penalty CMS Healthcare HHS OIG Overpayment

CMS to Postpone Denying Claims When Ordering/Referring Provider Not Enrolled in Medicare

The Centers for Medicare & Medicaid Services will implement edits on providers ordering/referring Part B, durable medical equipment and Part A home health agency claims effective January 6, 2014....more

12/3/2013 - CMS Denial of Benefits Medicaid Medicare

HHS Clarifies that ACA Qualified Health Plans are Not Subject to Federal Anti-Kickback Statute; Expresses Concern about Providers...

The U.S. Department of Health and Human Services recently announced that Qualified Health Plans (sold on and off the Exchanges) are not “Federal health care programs” for purposes of the federal anti-kickback statute. The...more

11/6/2013 - Affordable Care Act Anti-Kickback Statute Health Insurance Exchanges HHS Kickbacks Open Enrollment Qualified Health Plans

CMS Delays Edits to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare and Issues Proposed Rule on Enrollment...

The Centers for Medicare & Medicaid Services temporarily delayed the implementation of edits relating to ordering/referring practitioners that were scheduled to go into effect May 1, 2013, and issued a proposed rule with...more

5/13/2013 - Billing CMS Medicare

CMS Offers Partial Concession to Hospitals by Issuing Ruling, Proposed Rule on Part B Re-Billing

The U.S. Centers for Medicare & Medicaid Services (CMS) recently released both a “ruling” and a proposed rule intended to address growing concern among hospitals about billing Medicare Part B following a medical necessity...more

3/29/2013 - CMS Hospitals Medicare Medicare Part B

CMS to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare

Effective May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will begin to deny Part B Durable Medical Equipment (DME) and Part A Home Health Agency (HHA) claims for services or supplies when the...more

3/20/2013 - CMS Durable Medical Equipment Home Health Agencies Medicare National Provider identifier

The American Taxpayer Relief Act of 2012 and Anticipated Medicare and Medicaid Payment Reforms

On January 1, 2013, the U.S. Congress approved the American Taxpayer Relief Act of 2012 (the Act), concluding a protracted debate on how to prevent the United States from falling over the proverbial “fiscal cliff.” President...more

1/9/2013 - American Taxpayer Relief Act Fiscal Cliff Income Taxes Medicaid Medicare

Reimbursement Issues Facing Molecular Pathology Services in Calendar Year 2013 and Beyond

The Centers for Medicare & Medicaid Services recently issued final regulations and a final payment guidance that address reimbursement for laboratories furnishing molecular pathology services. While the publications answer...more

11/15/2012

Overview of 2013 Final Rule on DME Written Order and Face-to-Face Encounter Requirements

In the 2013 Medicare Physician Fee Schedule final rule, the Centers for Medicare & Medicaid Services significantly expands the list of durable medical equipment (DME) items that will require a face-to-face encounter and...more

11/14/2012

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