Ober|Kaler - Health Law Group

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Baltimore, MD 21202, United States

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OIG Determines $4.3 Million Improperly Paid to LTCHs for Interrupted Stays in 2010 and 2011

The OIG issued a report on June 3, 2014 summarizing its findings concerning the vulnerabilities and enforcement of Medicare’s interrupted-stay policy for long-term care hospitals (LTCHs). Beneficiaries in LTCHs tend to have more…more
| Health

CMS Publishes Proposed 2015 OPPS and ASC Payment Rule

On July 3, 2014, CMS posted the proposed CY 2015 outpatient perspective payment system (OPPS) and Ambulatory Surgical Center (ASC) payment rule, which was subsequently published in the Federal Register on July 14, 2014 [PDF]…more
| Health

Worthless Services/Substandard Quality of Care Criminal Prosecutions May Be on the Rise

If you are an operator of a skilled nursing facility (SNF), you might have faced the reality of insufficient medical staff and how it impacts your ability to deliver quality patient care to your residents. Or, you might have…more
| Criminal Law, Personal Injury, Health

AMA Issues Telemedicine Guidelines

On June 11, 2014, the American Medical Association (AMA) released a new set of telemedicine principles, which emerged from its policy report addressing “Coverage and Payment for Telemedicine.” The AMA report details the limited…more
| Health, Science, Computers, & Technology

CMS Proposes Relief for HH Face-to-Face and Therapy Reassessment Requirements

In the last issue, we reported on the difficulties faced by home health agencies (HHAs) in complying with the documentation requirements for the face-to-face (F2F) encounter between a patient and a physician before or shortly…more
| Health

CMS Announces Provider Relations Coordinator for RAC and MAC Issues

CMS recently announced that it has established a CMS Provider Relations Coordinator, Latesha Walker, to assist providers in resolution of issues with Recovery Auditor Contractors (RACs) and Medicare Administrative Contractors…more
| Health

Jury Verdict Against Millennium Provides Insight on Definition of Remuneration

Ameritox won the latest volley of an ongoing legal battle with Millennium when a federal jury in Florida awarded it $14.75 million on June 16, 2014. Ameritox persuaded the jury that Millennium’s free point of care test (POCT)…more
| Civil Remedies, Business Torts, Health, Science, Computers, & Technology

Privilege Upheld for Internal Investigation Preceding False Claims Act Litigation

The D.C. Circuit recently issued an important decision upholding the attorney-client privilege to protect corporate internal investigations. In re: Kellogg Brown & Root, No. 14-5055, 2014 BL 180217 (D.C. Cir. June 27, 2014)…more
| Civil Procedure, Commercial Law & Contracts, Health, Government Contracting

OIG Special Fraud Alert Questions Laboratory Payments to Physicians

On June 25, 2014, the Office of the Inspector General (OIG) issued a Special Fraud Alert addressing the issue of remuneration offered and paid by laboratories to referring physicians. The Special Fraud Alert expands upon…more
| Health, Science, Computers, & Technology

HHS to Continue Enforcing Orphan Drug Exclusion from 340B Program

The Department of Health and Human Services (HHS) through its Office of Health Resources and Services Administration (HRSA) announced last week that, although a court recently struck down its regulation addressing application of…more
| Administrative Law, Health, Science, Computers, & Technology

Home Health Face-to-Face: Continuing Deficiencies and Possible Relief

The Affordable Care Act mandates that a Medicare beneficiary have a “face-to-face” (F2F) encounter with a physician before the physician can certify that the patient is homebound and in need of skilled care and thus qualifies…more
| Health

The Self-Referral Disclosure Protocol: Settlement and Enforcement Trends (Presentation)

The Self-referral Disclosure Protocol (SRDP) permits health care providers to voluntarily disclose violations of the federal physician self-referral law, also called the Stark law. Emily Wein has presented a webinar discussing…more
| Health

Proposed Hospice Rule Focuses on Unbundling of Services

On May 8, CMS released a proposed rule in the Federal Register providing for a payment increase of 1.3 percent for fiscal year (FY) 2015. Among other provisions, CMS’s proposed rule offers hospice providers an update on hospice…more
| Health

CMS Issues Cost Savings Reforms to Medicare Regulatory Requirements

On May 12, 2014, CMS issued a final rule, reforming certain Medicare regulatory requirements and eliminating those identified as unnecessary, obsolete, or excessively burdensome. Many of the streamlined provisions relate to…more
| Health

Medicare Proposes Prior Authorization Process for Certain DMEPOS Items

On May 28, 2014, CMS issued a proposed rule to establish a permanent prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are “frequently subject to…more
| Health, Science, Computers, & Technology
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