Medicare

CMS Issues Final MLR Rule for Medicare Advantage and Part D Programs

by Roy M. Albert, Susan Berson | Mintz Levin - Health Law on 5/22/2013

Last week, CMS published a final rule implementing the ACA’s medical loss ratio (“MLR”) requirements that will apply to the Medicare Advantage (Part C) and prescription drug (Part D) programs beginning in contract year 2014. ...more

Groundhog Day for Tuomey: Jury Finds Hospital Violated Stark Law and False Claims Act

by Darby C. Allen, Donna S. Clark | BakerHostetler on 5/22/2013

On May 8, 2013, a jury in the Columbia Division of the U.S. District Court for the District of South Carolina returned a verdict finding that Tuomey Healthcare Systems, Inc. (Tuomey) violated the Stark Law and the federal...more

Proper Disclosure and Documentation the Focal Point in New HIPAA and Medicare Rules

by Stacey Borowicz, Tyler N. Williams | Dinsmore & Shohl LLP on 5/21/2013

New HIPAA Rule Affects Providers’ Notice of Privacy Practices - The Health Insurance Portability and Accountability Act (“HIPAA”) requires health care providers to inform patients of the providers’ legal duties and the...more

CMS Announces $1 Billion in Funding for Innovation Grants

by King & Spalding on 5/21/2013

On May 15, 2013, CMS released a funding opportunity announcement for round two of the Health Care Innovation Awards. The grants are administered by the CMS Innovation Center, which is authorized by the Affordable Care Act to...more

NOIs Due Soon to Apply for 2014 ACO Program

by Sarah E. Swank | Ober|Kaler on 5/20/2013

The Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) established under the Affordable Care Act is about to kick-off its second year with a new round of applications for the January 1, 2014...more

Does A Person Submitting False Medicare Bills Abuse The Trust Of The Doctor Making Money Off Of The False Bills?

by Matthew G. Kaiser | The Kaiser Law Firm PLLC on 5/17/2013

Hiring is always hard, especially in a small office. You have work that needs to be done. You can't do it all. Maybe you're a professional, like a doctor, and some of the work isn't the best use of your time....more

CMS Proposes New Standard for Hospital Inpatient Admissions

by Leslie Demaree Goldsmith | Ober|Kaler on 5/17/2013

As part of its proposed inpatient prospective payment systems (IPPS) rule for FY 2014, CMS introduced a new standard for determining whether an inpatient admission to an acute care hospital is appropriate. Specifically, CMS...more

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

by Robert Wolin | BakerHostetler on 5/17/2013

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

Jury Ruled in Tuomey Healthcare Retrial that the Hospital Violated the Stark Law and False Claims Act

by King & Spalding on 5/17/2013

On May 8, 2013, a jury concluded that Tuomey Healthcare System, Inc. (Tuomey), a community hospital in Sumter, S.C., violated the Stark law for allegedly improper compensation arrangements in 2005 between the hospital and 19...more

Increased Spotlight on Emergency Department Facility Coding by CMS, HHS and DOJ

by Gregory Brodek | Duane Morris LLP on 5/16/2013

Although the professional component of coding for evaluation and management services ("E&M Services") has been scrutinized over the years, until recently, little attention has been given to coding practices for the facility...more

Members of Senate Finance Committee Call for Repeal of Physician SGR, Seek Input from Provider Community

by King & Spalding on 5/15/2013

On May 10, 2013, Senators Max Baucus (D-MT) and Orrin Hatch (R-UT)—the Chairman and Ranking Member of the Senate Finance Committee, respectively—issued a letter to the healthcare provider community declaring that “[t]he...more

Health Care Reform Update -- May 13, 2013

by Joseph P. Hammang, Alexander Hecht, Abby Matousek, Jeremy Rabinovitz | Mintz Levin - Health Law on 5/15/2013

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

Sixth Circuit Applies Strict Precondition of Payment Requirement to Reverse $11.1 Million FCA Judgment

by Nicholas Linder, Kirsten Mayer, Arefa Shakeel | Ropes & Gray LLP on 5/15/2013

The U.S. Court of Appeals for the Sixth Circuit, in United States ex rel. Hobbs v. MedQuest Associates, Inc., 711 F.3d 707 (6th Cir. April 1, 2013), recently reversed an $11.1 million False Claims Act (“FCA”) judgment,...more

OIG Issues Updated Bulletin on Exclusion from Federal Health Care Programs

by Aaron Graham | Bradley Arant Boult Cummings LLP on 5/14/2013

On May 8, 2013, the Office of Inspector General (OIG) issued an updated Special Advisory Bulletin on the effect of exclusion from federal health care programs. A federal health care program (e.g., Medicare and Medicaid) is...more

Short Wins - Missing Evidence, Medicare Fraud, And How Normal People React To Federal Prosecutions

by Matthew G. Kaiser | The Kaiser Law Firm PLLC on 5/14/2013

There was only one published criminal case in the federal circuits last week where the defendant won. It's a good case on jury instructions for missing evidence, and the short write up is below....more

CMS Delays Edits to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare and Issues Proposed Rule on Enrollment...

by Joan Polacheck, Monica Wallace | McDermott Will & Emery on 5/13/2013

The Centers for Medicare & Medicaid Services temporarily delayed the implementation of edits relating to ordering/referring practitioners that were scheduled to go into effect May 1, 2013, and issued a proposed rule with...more

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CMS Issues Final MLR Rule for Medicare Advantage and Part D Programs

Groundhog Day for Tuomey: Jury Finds Hospital Violated Stark Law and False Claims Act

Proper Disclosure and Documentation the Focal Point in New HIPAA and Medicare Rules

CMS Announces $1 Billion in Funding for Innovation Grants

NOIs Due Soon to Apply for 2014 ACO Program

Does A Person Submitting False Medicare Bills Abuse The Trust Of The Doctor Making Money Off Of The False Bills?

CMS Proposes New Standard for Hospital Inpatient Admissions

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

Jury Ruled in Tuomey Healthcare Retrial that the Hospital Violated the Stark Law and False Claims Act

Increased Spotlight on Emergency Department Facility Coding by CMS, HHS and DOJ

Members of Senate Finance Committee Call for Repeal of Physician SGR, Seek Input from Provider Community

Health Care Reform Update -- May 13, 2013

Sixth Circuit Applies Strict Precondition of Payment Requirement to Reverse $11.1 Million FCA Judgment

OIG Issues Updated Bulletin on Exclusion from Federal Health Care Programs

Short Wins - Missing Evidence, Medicare Fraud, And How Normal People React To Federal Prosecutions

CMS Delays Edits to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare and Issues Proposed Rule on Enrollment...

Weigh In with Comments on CMS Proposed Rule for Medicare IRP by June 28

HHS OIG Issues Report on Hospice General Inpatient Care Billing

CMS Issues Proposed Hospice Payment Update for FY 2014

Health Care Reform Update -- May 6, 2013

Mcnees Insights - Asset Planning and Federal Taxation - Spring 2013

Gray Divorce: Social Security and Medicare

Phase Two Edits - Temporarily on Hold

Recent Court Decisions Affecting DSH Percentage Calculations May Impact Participation in the 340B Drug Discount Program

CMS Proposes Prospective Payment System Update Rules for Inpatient and Long Term Care Hospitals

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