News & Analysis as of

Healthcare Physician Payments

Foley & Lardner LLP

Compliance Compass: The Erlanger Complaint – A Cautionary Reminder About the Importance of FMV

Foley & Lardner LLP on

Although most health care lawyers and compliance officers who review and analyze physician compensation understand that fair market value (FMV) is important, the nuances around FMV are sometimes missed....more

Polsinelli

The Future Is Now: CMS Proposes Broad Bundled Payment Expansion for Cardiac Care Episodes

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Furthering the agency’s stated intention to pay for value over volume, the Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule representing the first expansion of mandatory hospital-centric bundled...more

Polsinelli

Payment Innovation: 30 Day Window to Provide CMS Comments on Physician Payment Changes Under MACRA Begins

Polsinelli on

On September 28, 2015, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) seeking stakeholder comments related to innovative physician payment models required by the Medicare Access...more

McGuireWoods LLP

CMS Releases Data Regarding Hospital and Physician Utilization

McGuireWoods LLP on

CMS recently announced that it would be releasing Medicare hospital utilization and payment data, as well as physician and supplier utilization and payment data. This is the third year that the hospital data has been released...more

King & Spalding

CMS Open Payment Program Data Indicates $6.49 Billion Paid by Manufacturers, GPOs to Physicians and Hospitals in 2014

King & Spalding on

CMS recently released data collected through the Open Payments Program in accordance with the Affordable Care Act from applicable manufacturers and group purchasing organizations (GPOs) about payments and other transfers that...more

Polsinelli

The OIG Wants You to Know It Is Targeting Physicians - The OIG's June 2015 Fraud Alert

Polsinelli on

On June 9, 2015, the HHS Office of Inspector General (OIG) issued a Fraud Alert that cautions physicians about questionable medical directorship and office staff arrangements. [Alert available here]. In the Fraud Alert, the...more

Sheppard Mullin Richter & Hampton LLP

New Venture Seeks to Support Independent Physicians in Texas

The Texas Medical Association (TMA) and Blue Cross Blue Shield of Texas are launching a new services company, TMA PracticeEdge, to facilitate bringing the benefits of value-based reimbursements to the state’s independent...more

Mintz - Health Care Viewpoints

Illinois Legislature Passes Anti-Markup Law Applicable to Pathology Services

Last Thursdday both chambers of the Illinois legislature voted to override the Governor’s amendatory veto and passed Public Act 098-1127, which prohibits a physician from charging a markup on anatomic pathology services if...more

Epstein Becker & Green

Medicare's Proposed Home Health Rule for 2015: CMS Suggests Only Limited Relief to the Face-to-Face Encounter Documentation...

Epstein Becker & Green on

On July 7, 2014, the Centers for Medicare & Medicaid Services ("CMS") published proposed changes to the Medicare Home Health Prospective Payment System ("HH PPS") for calendar year 2015 ("Proposed Rule"). The Proposed Rule...more

Faegre Drinker Biddle & Reath LLP

CMS Wants To Shine Light On CME Payments To Physicians

It’s a question CMS has been wrestling with since the enactment of the Sunshine Act (sometimes called the Open Payments Program) as part of the Affordable Care Act. The Sunshine Act generally requires a manufacturer to...more

The Volkov Law Group

The Intractable Problem of Medicare Fraud

The Volkov Law Group on

You have to admire the vigilance and dedication of prosecutors and law enforcement investigators who fight Medicare fraud. There is no question that they have ramped up enforcement and promoted a strong message of deterrence....more

Ballard Spahr LLP

OIG Releases Special Fraud Alert on Laboratory Payments to Physicians

Ballard Spahr LLP on

The Office of the Inspector General (OIG) for the Department of Health and Human Services recently issued a Special Fraud Alert regarding laboratory payments to referring physicians. The Special Fraud Alert reaffirms OIG’s...more

Sheppard Mullin Richter & Hampton LLP

Cloudy Skies Ahead for Providers? CMS’ Release of Medicare Billing Data Combined with Physician Payment Sunshine Act Data May...

In February 2013, we reported (on our Healthcare Law Blog) that the Centers for Medicare and Medicaid Services (CMS) announced the final rule for the Physician Payments Sunshine Act. In the interest of providing more...more

Faegre Drinker Biddle & Reath LLP

AMA To Recommend Physicians Be Paid For End-Of-Life Planning

Brace yourself for a reprise of the death panel debate of 2009. The AMA will soon formally recommend to CMS that physicians be paid—or “reimbursed” in health care-speak—for talking with Medicare patients and their families...more

Sheppard Mullin Richter & Hampton LLP

How Are Your Physicians Compensated? Stark Law + False Claims Act = Halifax Paying $85 Million

On March 10, 2014, just days before trial, Halifax Hospital Medical Center and Halifax Staffing, Inc. (collectively “Halifax”) entered into an $85 million settlement with the U.S. Department of Justice resolving allegations...more

Mintz - Health Care Viewpoints

Health Care Update

In This Issue: - Transparency Latest Weapon against Rising Health Care Costs - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives -...more

Baker Donelson

Maryland Health Care Commission Proposes to Extend and Revise EHR Incentive Regulations

Baker Donelson on

On March 21, 2014, the Maryland Health Care Commission (MHCC) published proposed revisions to the existing Maryland Electronic Health Record Incentives regulations at COMAR 10.25.16. The proposed regulations [PDF] would...more

McCarter & English, LLP

Health Law Insights Newsletter - April 2014

In This Issue: - Federal Updates - State Updates - HIPAA Updates - Excerpt from Centers for Medicare & Medicaid Services Issues Guidance for Meaningful Use Hardship Exception: The Centers...more

Mintz - Health Care Viewpoints

Health Care Update

In This Issue: - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other Health Care News - Upcoming Hearings and Markups ...more

King & Spalding

MedPAC Issues Draft Recommendations For 2015 Medicare Payments

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The Medicare Payment Advisory Commission (MedPAC) met on December 12-13, 2013, to discuss draft recommendations regarding 2015 payment updates for Medicare providers. MedPAC, which is responsible for issuing an annual...more

BakerHostetler

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

BakerHostetler on

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

Baker Donelson

Complex Chronic Care Management Reimbursement for 2015 Included in Proposed 2014 Physician Fee Schedule

Baker Donelson on

The proposed 2014 Medicare Physician Fee Schedule [PDF] included reimbursement for case management to be made available in 2015 for physicians who treat patients with two or more complex conditions. The proposed rule would...more

Mintz - Health Care Viewpoints

The Countdown Begins – Sunshine Act Data Collection

With the August 1 deadline for data collection under the Physician Payments Sunshine Act (the “Act”) looming, CMS recently released two mobile applications (“Apps”) to help physicians and industry track payments and transfers...more

Jackson Walker

Sunshine Act Requires Reporting All Payments to Physicians

Jackson Walker on

Beginning August 1, 2013, manufacturers of Medicare or Medicaid covered drugs, medical devices, biologicals and medical supplies must collect and make publicly available data on physicians and teaching hospitals with whom the...more

Mintz - Health Care Viewpoints

Increased Availability of Health Care Data Means More Oversight and More Litigation

The increasing availability of health care claims and payment data may portend the future of government and private health care enforcement and litigation. ...more

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