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Now is the Time to Prepare for MACRA: 2017 Will Bring Major Changes to Physician Medicare Reimbursement

MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) is bi-partisan legislation that was enacted to change Medicare reimbursement from being based on the current system of volume of services provided to...more

When a Discount May be a Kickback

Healthcare providers of all kinds, as well as medical equipment suppliers, have traditionally relied upon discounts as a legitimate means of attracting patients and commercial clients without running afoul of the federal...more

What does the Escobar Decision Mean for Healthcare Providers?

On June 16, 2016, the U.S. Supreme Court in Universal Health Servs., Inc. v. United States ex rel Escobar, No. 13-317, — S. Ct. — (June 16, 2016), confirmed that the implied certification theory may serve as a basis for...more

Federal Court finds “Systemic Failure” in Processing of Administrative Appeals for Medicare Reimbursement Claims

A win for efficiency: The AHA suit may force shorter adjudication times for Medicare administrative appeals. In 2014, the American Hospital Association (AHA), along with three hospital systems, filed suit against the U.S....more

New CMS rule clarifies when 60-day overpayment clock starts ticking

Four years after publication of its proposed rule related to reporting and returning overpayments within 60 days, CMS has issued a final rule that responds to comments and provides greater clarity. The published rule is under...more

Legislature Reins in Addiction Recovery Residences

Florida law makers have decided it is high time to stop allowing addiction recovery residences to operate without regulatory oversight. In its last session, the Florida Legislature passed a new law (CS/CS/HB 21) requiring...more

OIG Now Targeting Physician Compensation Arrangements

In a Fraud Alert issued on June 9, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG) notified the healthcare community that physician compensation arrangements are on the OIG’s radar...more

OIG Issues Compliance Guidance for Healthcare Governing Boards

Members of healthcare governing boards now have direction from the OIG as to what is expected of them as they oversee the regulatory compliance of their organizations. And the good news is that the board members don’t have to...more

Court Allows Counterclaim Against Whistleblower for Breach of Employment Agreement

A federal court in New Jersey has permitted a defendant in a False Claims case to defend itself on the grounds that the whistleblower/ex-employees breached their employment agreements by using and disclosing confidential...more

New OIG Special Fraud Alert Aimed at Laboratory Payments to Referring Physicians

On June 25, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert entitled "Laboratory Payments to Referring Physicians."...more

7/11/2014  /  Fraud , Healthcare , Healthcare Fraud , HHS , OIG , Physicians

Providers On Prepayment Review May Now Face Exclusion From Medicare

Providers on prepayment review could be facing exclusion from Federal healthcare programs if they don't correct the problems which caused them to be subject to prepayment review. CMS has directed its contractors to consider...more

1/9/2014  /  CMS , Healthcare , Medicaid , Medicare

New Medicare Regulations Require Face-to-Face Physician Encounters for DME Products

On November 16, 2012, the Centers for Medicare & Medicaid Services ("CMS") published a final rule making various changes to payment policies under the Physician Fee Schedule. Included in this rule is a new requirement that...more

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