Billing

News & Analysis as of

Third Circuit Rejects Class Certification in Yet Another Consumer Case

Consistent with its recent emphasis on the stringency of class certification requirements in consumer cases, the Third Circuit recently affirmed the denial of class certification in a consumer case involving alleged...more

Move Over, Billable Hour; There's a New IP Fee Arrangement in Town

The practice of law has changed greatly over the past decades. We have witnessed great growth in solo and small firm practice, as well as a large movement to in-house practice. We are even seeing growth in freelance attorneys...more

The End of the Hour

Before the twentieth century, state law prescribed set fees for specific legal services, and litigation fees were usually paid by the losing parties. Over time, maximum fee laws were repealed, and by the early twentieth...more

HHS OIG Issues Report on Questionable Billing for Medicaid Pediatric Dental Services

What you need to know: The Office of Inspector General for the US Department of Health & Human Services recently published the results of its study on Louisiana dentists who may be providing unnecessary dental...more

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

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

FTC Releases Staff Report on Mobile Phone Bill Cramming

On July 28, 2014, the Federal Trade Commission (“FTC”) released a report, entitled “Mobile Cramming: An FTC Staff Report” (“Report”). The Report focuses on, and makes recommendations regarding, the mobile payment option...more

Focus on “shadow hours” misses the point of AFAs

Aric Press of American Lawyer penned a terrific article, What the Rise of Pricing Officers Says About Big Law’s Future. The article, reflecting the results of a recent survey, offers some great insights into the move to...more

Got Medicare Billing Privileges? Are You Sure? Traps for the Unwary in Medicare Enrollment

To receive payment for items and services furnished to Medicare beneficiaries, a health care professional or facility must have approved Medicare billing privileges, which requires enrollment in the Medicare program. Failure...more

General Counsel To Lawyers: “Do You Understand AFAs?”

Earlier this week, I recapped one component of the General Counsel Panel at this year’s LSSO RainDance conference I attended. It focused on a request these General Counsel had, which was for lawyers to “know our...more

Points & Authorities - Spring 2014

In this Issue: - AB 1000 and Corporate Practice in California: More than Meets the Eye—or Less? - Loose Lips Sink Ships and Careless E-mails Torpedo a Transaction - New Faces - Points from the...more

The Halifax $85 Million Lesson: Compensation Arrangements Between Hospitals and Physicians Must Be Reviewed

The Department of Justice (“DOJ”) announced another multi-million dollar settlement of alleged False Claims Act violations on March 11, 2014. Specifically, Halifax Hospital Medical Center and Halifax Staffing, Inc. agreed to...more

Recent District Court Case Highlights State Variation in Applying Corporate Practice of Medicine and Global Billing Restrictions...

On March 25, 2014, the U.S. District Court for the District of Minnesota held that a magnetic resonance imaging ("MRI") provider, a lay entity (i.e., not owned or controlled by physicians), did not violate the state's...more

Working The Data

This morning as I prepared to write this, a headline flashed across my screen that an exploration company that is not part of the search team for the missing Malaysian airliner claims to have located wreckage that might be...more

CMS Releases Physician Medicare Billing Data

The U.S. Department of Health and Human Services (HHS) announced on April 9th a “historic” release of Medicare payment data to provide consumers with “unprecedented transparency on the medical services physicians provide and...more

Court Confirms Arbitration Award In Reinsurance Billing Dispute

A New York federal district court affirmed an arbitration award in favor of R&Q Reinsurance Company as against its cedent, Utica Mutual, in a reinsurance dispute arising from certificates issued by R&Q reinsuring certain...more

2014 OIG Work Plan: Questionable Billing Patterns for Part B Services During Nursing Home Stays

The 2014 OIG Work Plan includes the following: Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home...more

What Your Financial Statements Tell your Lender about Your Firm

For personal injury attorneys working on contingency, securing a loan to finance case/trial costs and working capital is a great alternative when compared to partners using their own capital to fund the firm and their cases....more

OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare

H.H.S’s Office of Inspector General’s yearly work plan was issued on 31 January 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review...more

Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For “Incident To” Services Means For Medicare Providers.

In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies...more

MMIS and NCTracks: New is Not Always Better

New is not always better. In December 2008, the Department of Health and Human Services (DHHS) awarded a contract to Computer Sciences Corporation (CSC) to develop and implement a replacement billing system for Medicaid...more

S.D.N.Y. Dismisses Putative TILA Class Action Based On Credit Card Billing Practices

On October 18, the United States District Court for the Southern District of New York dismissed a putative TILA class action alleging that a bank made improper interest rate disclosures on credit card bills and assessed...more

Preview: Silicon Valley In-House Counsel Panel - LMA Bay Area  [Video]

A preview of the LMA Bay Area's program, 'In-House Counsel Summit: New Realities in Delivering Legal Services.' The economics of the legal industry have fundamentally changed with the current recession. Overall demand for...more

The Code War: The international classification of diseases and why you should care about a big change on the horizon

Coming soon to a courtroom near you: “Mr. Expert, can you tell us what upcoding is and whether you found it in Dr. Smith’s billing for treating the plaintiff?” the defense lawyer asked her medical coding...more

Doc Wishes He Showed Up at the Office — But . . .

Imagimed LLC, an MRI Center, its owners and chief radiologist, agreed to pay the government $3.57 million to settle false claims allegations for MRI services. The government alleged that Imagimed billed for MRI scans...more

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