Robert Wolin

Robert Wolin


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Latest Posts › Medicare


The Deeper Dive: C-Suite to Prison Pipeline

In recent years, the U.S. Department of Justice (DOJ) has been criticized for failing to prosecute executives for fraud, particularly in the financial sector. In response, the DOJ has begun to more heavily emphasize...more

6/29/2015 - Ambulance Providers CEOs DOJ Durable Medical Equipment Enforcement Enforcement Actions Fraud Healthcare Fraud Home Health Agencies Hospitals Medicare Personal Liability Pharmaceutical Industry Pharmacies White Collar Crimes

Five Things to Know About the Medicare SGR Fix

H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), was signed into law by President Obama on April 16, 2015. A broad bipartisan compromise measure, MACRA repeals the much-maligned sustainable growth rate (SGR)...more

4/27/2015 - CHIP Health Care Providers Hospitals Medicare Medicare Access and CHIP Reauthorization (MACRA) Physician Medicare Reimbursements Physician SGR Formula

2015 Medicare OPPS and ASC Final Rule

On November 10, 2014, the Centers for Medicare and Medicaid Services (CMS) published the Outpatient Prospective Payment System (OPPS) final rule for 2015. The rule updates CMS’s payment rates and policies, value-based...more

11/25/2014 - Ambulatory Surgery Centers CMS Final Rules Hospitals Medicare Medicare Part D OPPS

Government Sues Hospital for Birthing Mama’s Babies

The Clinica de la Mama case could well serve as an instruction manual of what not to do to stay out of the government’s crosshairs. In this case, several hospitals entered into contracts for Clinica de la Mama to provide...more

8/19/2014 - Healthcare Healthcare Fraud Hospitals Medicare

IPPS Proposed Rule: Read Once, Then Take an Aspirin

The Centers for Medicare and Medicaid Services (CMS) has set its sights on the quality of care during hospital inpatient stays and much, much more. On May 15, 2014, CMS published a proposed rule that would update Medicare...more

5/16/2014 - CMS Healthcare Healthcare Reform Hospitals Inpatient Billing Inpatient Prospective Payment System (IPPS) Long-Term Care Medicare

So Much for Stop, Drop and Roll: CMS Proposes New Fire Safety Update

CMS has announced a proposed rule updating Medicare/Medicaid fire safety standards. In particular, CMS proposes to adopt the National Fire Protection Association’s (NFPA) 2012 edition of the Life Safety Code (LSC) and the...more

5/8/2014 - CMS Medicaid Medicare Safety Precautions

Never Fear Regulatory Violations – Focus on Conditions to Payment

The U.S. Court of Appeals for the Fourth Circuit recently upheld the dismissal of a False Claims Act (FCA) suit against Omnicare, Inc., in which the relator alleged that certain drugs repackaged by Omnicare’s subsidiary were...more

3/11/2014 - False Claims Act (FCA) FDA Healthcare Medicaid Medical Reimbursement Medicare Pharmaceutical Industry Prescription Drugs

CMS – Doc, if You Want a Free Book Go to the Library

The Centers for Medicare and Medicaid Services (CMS) recently denied a request from a bipartisan group of 23 members of congress to exempt the distribution of textbooks and scientific peer-reviewed medical journal materials...more

1/24/2014 - CMS Medicare Physician Medicare Reimbursements Reporting Requirements Textbooks

CMS Outpatient and Physician Payment Rules: Don't Miss the Efficient Quality of Care Reform Forest for the Dollar Trees

The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more

12/13/2013 - ACOs Ambulatory Surgery Centers CMS Healthcare Hospitals ICD Codes Medicare Outpatient Quality Reporting Patient Prospective Payment System Physician Payments PQRS Value-Based Purchasing

Pay to Play Quickly — CMS's New Slow Motion Surveys for Acquirers Rejecting Assumption of Medicare Agreements

The Center for Medicare and Medicaid Services (CMS) recently issued a policy memorandum to state survey agency (SSA) directors regarding the effect of rejecting a Medicare agreement in connection with the acquisition of a...more

9/23/2013 - Affordable Care Act CMS Healthcare Reform Medicare Pay or Play

Physician Medicare Data: Has the Drought Ended?

After 34 years, a federal district court in Florida has overturned a 1979 injunction which prevented the Centers for Medicare and Medicaid Services (CMS) from releasing to the public Medicare data related to physician billing...more

6/18/2013 - CMS Disclosure FOIA Medicare Physician Payments Physicians Privacy Laws

Bringing Sunlight to Healthcare Pricing: The CMS Release of Hospital Charge Data

Former U.S. Supreme Court Justice Louis D. Brandeis once said that "Sunlight is the best disinfectant." The release of charges billed by some 3,337 Medicare hospitals for 100 of the most common inpatient diagnosis related...more

5/17/2013 - Affordable Care Act CMS Healthcare Hospitals Medicare Payment Plans

No Sale -- Sales Commissions Violate Anti-Kickback Statute; Prevent Enforcement of Nonsolicitation

A durable medical equipment (DME) distributor, Joint Technology, Inc., entered into an agreement to pay a salesman commissions ranging from 18 to 22 percent on the volume of his sales. The court held that the salesman did not...more

3/13/2013 - Anti-Kickback Statute Medicaid Medicare Non-Compete Agreements Non-Solicitation Agreements Sales Commissions

Too Big to Exclude; Too Much Wrongdoing to Ignore

A 2007 audit initiated by a Medicare Program Safeguard Contractor (PSC) discovered that a North Carolina provider had a high incidence of inpatient billings for patients who did not stay in the hospital overnight. The PSC's...more

2/26/2013 - CMS Deferred Prosecution Agreements False Statements Medicare

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