Norman Tabler, Jr.

Norman Tabler, Jr.

Faegre Baker Daniels

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HHS Asserts the Everybody-Does-It Defense

If that sounds familiar, your child may have a future as a lawyer for Health & Human Services. Because that’s one of the primary arguments asserted by HHS last Friday in its motion to dismiss the lawsuit by the American...more

9/16/2014 - American Hospital Association Delays HHS Hospitals Medicare Medicare Appeals Council Motion to Dismiss

Attention Hospitals! Act Now To Get 68 Cents For Your Medicare Dollar!

It’s no secret that CMS is drowning in appeals from denials of Medicare claims for inpatient care. The number of pending appeals was estimated at half a million back in February, and it’s only grown since then. One reason...more

9/15/2014 - Appeals CMS Hospitals Medicare Two-Midnight Rule

Want To Complain About The 2015 Medicare Physician Fee Schedule? Take A Number.

Apparently Americans feel that way about Medicare’s traditional fee-for-service physician compensation schedule. Everybody complains about it, but nobody likes any proposed changes. That’s clear from the reaction to the...more

9/15/2014 - CMS Fee-for-Service Health Insurance Healthcare Medicare Physician Fee Schedule Physicians Public Comment Trade Associations

Court Rejects Hospital’s ADA Argument That Proves Too Much

Dr. Robinson is an obstetrician at St. Francis Hospital. A diabetic, he underwent surgery for a broken foot and can’t always remain standing throughout deliveries. So he uses a rolling stool and practices from a seated...more

9/11/2014 - ADA Hospitals Physicians Reasonable Accommodation Title III

Imagination-in-Pleading Award

When Oklahoma Blue Cross-Blue Shield terminated Dr. Gude’s provider agreement, he decided to fight back. He sued the Blues in federal court, alleging they had violated—and this is the imaginative part—Oklahoma’s Consumer...more

9/10/2014 - Blue Cross Blue Shield Breach of Contract Consumer Protection Act Health Care Providers Healthcare

Is Interstate Physician Licensing on the Horizon?

Physician licensing is, and always has been, a matter for the states. But ease of travel from one state to another has long placed a strain on that approach, as physicians and patients alike move easily from one state to...more

9/9/2014 - Cross-Border Healthcare Licenses Licensing Rules Physicians

Most-Invasive-Procedure-of-the-Month Award

Back in 2010 the police asked Dr. LaPaglia to conduct a body cavity search of Felix Booker. They were looking for illegal drugs. Dr. LaPaglia said yes and proceeded. First, he paralyzed Felix with drugs (legal ones). Then...more

9/8/2014 - Civil Rights Act Hospitals Physicians Professional Liability

Eighth Circuit Decision Tilts Rule 9(b) Split toward Whistleblowers

Last Friday’s Eighth Circuit decision in Thayer v. Planned Parenthood of the Heartland favored the whistleblower in the ongoing controversy over specificity requirements in False Claims Act actions. The split had been even...more

9/5/2014 - False Claims Act Planned Parenthood Whistleblowers

OIG Okays Medigap Insurer’s Arrangement for Discount on Inpatient Deductibles

Last Monday the Office of Inspector General (OIG) of Health & Human Services posted an advisory opinion (No. 14-07) allowing a Medigap insurance company to strike a deal with hospitals for discounts—even waivers—of the...more

8/28/2014 - Advisory Opinions Deductibles Discounts Healthcare HHS Hospitals Inpatient Billing Insurers Medicare Medigap OIG

AHA Renews Complaints about OIG Hospital Compliance Reviews

The American Hospital Association (AHA) has renewed its complaints about OIG “hospital compliance reviews.” Last Thursday AHA Executive Vice President Rick Pollack sent a letter to Health & Human Services Secretary Burwell...more

8/26/2014 - American Hospital Association Audits Chief Compliance Officers Hospitals OIG Recovery Audit Recovery Audit Contractor

OIG Rejects Pharmacy’s Plan for Per-Fill Referral Fees, Or Be Careful What You Ask For

Advisory Opinion No. 14-06, issued August 15, addressed a plan by the chain to reimburse local pharmacies for referrals of patients in need of specialized drugs that the local pharmacies did not dispense. In the scenario...more

8/26/2014 - Advisory Opinions Anti-Kickback Statute OIG Patient Referrals Pharmacies Referral Fees

Seventh Circuit Finds Worthless Services Case Worthless

Two nurses filed a whistleblower suit against the Illinois nursing home where they worked. Their theory was that the care provided at the home was so poor that it was worthless. So any bills to Medicare and Medicaid were...more

8/25/2014 - False Claims Act Medicaid Medicare Whistleblowers

August Scam-of-the-Month Award

It turns out that back in 2011 the hospital sold the right to use its hospital billing codes to free-standing clinics. So under the arrangement, when the clinics sent bills, they were hospital bills rather than clinic bills...more

8/22/2014 - Healthcare Fraud Hospitals Scams

Research Doesn’t Pay—At Least Not in Graduate Medical Education

Indirect graduate medical costs, or IGME, are what Medicare allows teaching hospitals in increased Medicare rates. IGME represents the indirect costs to a teaching hospital of hosting residents and interns—costs above and...more

8/21/2014 - Healthcare Medicare Physicians Students

Who Audits the Auditors?

Since the advent of Medicare in 1965, hospitals have bemoaned the cost and burden of Medicare audits. The complaints increased when CMS hired private contractors for the audits. They became deafening in 2009 with the advent...more

8/20/2014 - Audits CMS GAO Hospitals Medicare Recovery Audit Recovery Audit Contractor

IOM Study Recommends Major Changes in Graduate Medical Education Funding

An Institute of Medicine committee issued its long-awaited study on Graduate Medical Education (GME) funding on July 29, 2014. The committee, headed by two former Centers on Medicare & Medicaid Services administrators, Gail...more

8/20/2014 - Education Reform Healthcare Physicians

Unnecessary Surgeries Put Hospital in Three-Front War

When the government accuses a hospital of committing Medicare fraud by billing for unnecessary surgeries, the hospital has a real problem on its hands. It’s at war with the government, and that’s expensive, as well as...more

8/15/2014 - Healthcare Healthcare Fraud HIPAA Hospitals Medicare

What’s Scarier than a Compliance Officer Turned Whistleblower? A Whole Association of Them

In U.S. ex rel. Corporate Compliance Assocs. v. N.Y. Society for the Relief of the Ruptured & Crippled the court ruled that the whistleblower failed to meet the False Claims Act’s requirement that allegations be described...more

8/14/2014 - Anti-Kickback Statute Chief Compliance Officers Compliance False Claims Act Healthcare Healthcare Fraud Hospitals Stark Law Whistleblowers

Dark Clouds Over Sunshine Act

Once again the Obama administration has been tripped up in launching a healthcare-related online system. This time the problem concerns the Physician Payments Sunshine Act—the act that is supposed to enable the public to see...more

8/12/2014 - Affordable Care Act CMS Healthcare Healthcare Reform Physicians Sunshine Act

Deadline Looms for New PCORI Grant Applications

Wednesday the Patient-Centered Outcomes Institute announced the availability of up to $76 million in new grant money for comparative effectiveness research projects. But the deadline for prospective applicants to submit...more

8/11/2014 - Grants Medical Research PCORI Research Funding

Early Report on Value-Based Purchasing: Less to It Than Meets the Eye?

Medicare’s Value-Based Purchasing (VBP) program produced no improvement in either quality of care or patient satisfaction during its first nine months of operation. That’s the finding of a study led by Andrew Ryan, of the...more

8/8/2014 - Healthcare Hospitals Medicare Quality of Care Standards Value-Based Purchasing

Bundling Gains Momentum, Even as New Study Raises Questions

Health care cost bundling—the aggregating of all the costs of an episode of medical care into a single bill—seems to be here to stay. After all, it’s the way most all other billing is done. When your car is serviced, you...more

8/7/2014 - Billing CMS Health Insurance Medicare

Brace Yourself: The RACs Are Back

Under the controversial program private contractors audit hospitals and other Medicare providers for fraudulent and erroneous Medicare billing. Why is it controversial? Because the auditors are paid a percentage of...more

8/6/2014 - Audits Billing CMS Contractors False Billing Hospitals Medicare Recovery Audit Contractor

Most Recent Final Deadline for ICD-10 Implementation is October 1

It’s been a while since CMS set a new “final” deadline for implementation of ICD-10—the greatly expanded medical coding system. So last Thursday CMS issued a new final rule setting October 1, 2015, as the final date for...more

8/5/2014 - CMS Deadlines Final Rules ICD Codes

Does Medicare NOTICE Bill Miss the Point?

The bill would require hospitals to give meaningful notice to patients who have been assigned “observation” status for over 24 hours. Observation status is different from inpatient status under the rules of Medicare and other...more

8/4/2014 - Health Insurance Hospitals Inpatient Billing Medicare Notice Requirements

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