See below for the CMS (Centers for Medicare & Medicaid Services) Announcement on July 10, 2024 proposing a reduction in the Medicare Conversion Factor payment from $33.29 to $32.36, i.e. 2.8%...more
The Allegheny County Medical Society has reported that the Pennsylvania House of Representatives has passed a bill to bar non-compete agreements in healthcare employment....more
When negotiating physician compensation issues, hospitals frequently rely upon the premise they must pay fair market value compensation in order to comply with the provisions of the Stark Act prohibiting referrals in exchange...more
CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be...more
The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75....more
On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved,...more
2/3/2023
/ Employment Contract ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Independent Contractors ,
Non-Compete Agreements ,
Nonprofits ,
Physicians ,
Proposed Rules ,
Public Comment ,
Restrictive Covenants ,
Unfair Competition
The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. ...more
The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes,...more
On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor. ...more
HHS sent notices to noncompliant physicians and facilities on March 10, 2022 giving them 30 days to return funds paid to healthcare providers who have not complied with the agency’s reporting requirements....more
The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief.
On Tuesday, March 15, 2022, President Biden signed the Consolidated...more
There has been much discussion and controversy over the new CMS position on billing for split/shared services in facility settings.
As originally proposed, and starting in January 2022, if the service was shared among...more
There is almost universal agreement regarding predictions for 2022 federal enforcement in the following areas:
..The use of fraudulently obtained COVID relief funds in both healthcare and in general, but specifically as...more
1/20/2022
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Corporate Misconduct ,
Department of Justice (DOJ) ,
Enforcement ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Personal Liability ,
Physicians ,
Relief Measures ,
Yates Memorandum
CY 2021 Physician Fee Schedule Update -
On December 27, 2020, the Consolidated Appropriations Act modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS)...more
The COVID pandemic has illuminated the need to modernize professional licensing. Although professional licensing has always been a necessary vigilance with licensing has always been appropriate, and never more so than as...more
Attached is a PDF issued by CMS regarding blanket waivers of the Stark Law in order to allow physicians and hospitals to adjust 18 different potential financial relationships in order to deal with the COVID-19 emergency. The...more
While we are waiting for final disposition of the AKS Safe Harbors and Stark Exceptions proposed in October of 2019, since the comment period expired December 31, 2019 and final rules have not been issued, I thought we should...more
3/6/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Exceptions ,
Fair Market Value ,
Hospitals ,
Medicare ,
Physicians ,
Proposed Rules ,
Safe Harbors ,
Stark Law
On October 22, 2019, CMS and OIG (Office of Inspector General) released new proposed rules regarding Stark Law Exceptions and Anti-Kickback Safe Harbors in response to what has universally been christened as the “Regulatory...more
11/7/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Exceptions ,
Health Care Providers ,
OIG ,
Physicians ,
Proposed Rules ,
Regulatory Requirements ,
Safe Harbors ,
Stark Law ,
Value-Based Care
In October 2018, the National Practitioner Data Bank (NPDB) published the third edition of the NPDB Guidebook.
NPDB publishes monthly “NPDB insights”. I could not send the link to that, but I have attached a copy of the...more
The final Medicare 2019 Physician Fee Schedule https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html rule was posted on November 1, 2019, to be effective January 1, 2019. It includes...more
The 2019 proposed Medicare Fee Schedule was published on July 27, 2018 by CMS at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf.
Pages 61 through 91 of the Executive Summary are devoted to:...more
A new Telemedicine Act is wending its way through the legislative process in Pennsylvania. Senate Bill 780 of 2017 (attached hereto as a PDF) has been unanimously passed by the Senate and referred to the House Professional...more
Peer Review Confidentiality will become much more complicated with the addition of economic evaluation to physicians’ quality and efficiency. Physicians will be surprised to learn that many “reviews” to which they may...more
On April 23, 2018, CMS issued a request for information on direct provider contracting models. In that request, (attached hereto as a PDF), CMS stated as follows...more
The Pennsylvania Supreme Court ruled, on March 27, 2018, in Regenelli v. Boggs, Monogahela Valley Hospital and UPMC/ERMI that physician performance reviews of an ER physician, who was provided by ERMI to Mon Valley Hospital,...more