Norman Tabler, Jr.

Norman Tabler, Jr.

Faegre Baker Daniels

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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

What’s an MDDS? And Why Should I Care?

Last month the Food & Drug Administration (FDA) announced still further relaxation of its oversight over anything qualifying as a “medical device data system,” or MDDS. The announcement should come as welcome news to a great...more

8/1/2014 - Draft Guidance FDA Hospitals Manufacturers Medical Device Data System Medical Devices Physicians Software

CHI Takes the Plunge into the Insurance Business

For several years now hospital systems have been tip-toeing around the business of health insurance. They’ve been signing up for Medicare Advantage plans, taking on more and more risk, managing care and raiding health...more

7/31/2014 - Medicare Medicare Advantage

Hell Hath No Fury Like a CFO Scorned (But His Whistleblower Suit Fails Anyway)

Medicare and Medicaid providers lie awake at night worrying about disgruntled—or worse yet, fired—finance officers filing whistleblower suits. After all, Medicare and Medicaid regulations are notoriously complicated, and...more

7/30/2014 - False Claims Act Healthcare Whistleblowers

Finally, Some Good News for Halifax–And All Other–Hospitals

It’s been a long time since Orlando’s Halifax Hospital got any good news from the federal court hearing the whistleblower case brought by employee Elin Baklid-Kunz. Earlier this year the hospital had to agree to an $85...more

7/29/2014 - FCA Halifax Hospital Healthcare Healthcare Fraud Hospitals Medicare Stark Law Whistleblowers

Court Slams Medicare Agency, Notes Reputation As “Unfeeling Bureaucracy”

The Department of Health & Human Services’ Provider Reimbursement Review Board (Board) came in for some withering criticism last Friday from the federal court hearing the appeal of University of Chicago Hospital from the...more

7/28/2014 - Appeals Filing Requirements HHS Hospitals Medicare

CMS Proposes Elimination of CME Exemption From Sunshine Act

Teaching hospitals and physicians who speak at continuing medical education (CME) programs should be interested in a July 11, 2014, announcement by the Centers for Medicare & Medicaid Services (CMS). The announcement proposes...more

7/24/2014 - CME CMS Healthcare Hospitals Sunshine Act Teaching Hospitals

HHS Relabels Invalidated 340b Regulation As “Interpretative Rule”

Earlier this week HHS came out swinging in the latest round of its battle with the Pharmaceutical Research & Manufacturers of America (PhRMA) over the Affordable Care Act’s provisions on 340B and orphan drugs. HHS reasserted...more

7/24/2014 - Affordable Care Act Healthcare HHS Interpretive Rule Orphan Drugs Pharmaceutical PHRMA Section 340B

D.C. Circuit Says CMS Doesn’t Know What’s New

On Tuesday of last week the D.C. Circuit Court ruled that the Provider Review Reimbursement Board doesn’t know what’s new. It reversed the PRRB’s decision, along with the District Court’s decision that upheld it. In doing...more

7/18/2014 - CMS Healthcare Medicare New Hospital PRRB

Medicare Patients Caught In Two-Midnight Rule Crossfire

Hospitals have been complaining about the two-midnight rule since it was first announced. But mounting evidence indicates that Medicare patients themselves are suffering badly from the effects of the rule....more

7/15/2014 - Healthcare Hospitals Inpatient Billing Medicare Provider Payments Two-Midnight Rule

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