Medicare, Hospitals | JD Supra Law News

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

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

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

by Christine Morse | Ober|Kaler on 5/3/2013

A number of recent developments affecting the Disproportionate Share Hospital (DSH) percentage calculation methodologies will likely have significant impact on 340B covered entities. DSH hospitals that participate in the 340B...more

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

by Colin Roskey | Cozen O'Connor on 5/2/2013

On Friday, April 26, the Centers for Medicare and Medicaid Services (CMS) issued a crucial payment system rule that proposes updated rates and regulatory policies for inpatient hospitals (including inpatient psychiatric...more

CMS Releases Proposed FFY 2014 IPPS Rule

by Mark A. Stanley | Ober|Kaler on 5/2/2013

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a net increase in operating payments...more

CMS Issues Proposed Changes to LTCH Payment Rates and Other Payment Policies for Fiscal Year 2014

by Paul Pitts | Reed Smith on 5/2/2013

On April 26, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed update to the Medicare long-term acute care hospital prospective payment system (“LTCH PPS”) policies and payment rates for fiscal...more

Hospitals Prevail in Effort to Include Pennsylvania GA Days in the Medicare DSH Calculation

by Gregory Fliszar, Mark Gallant | Cozen O'Connor on 5/1/2013

Two of Mercy Health System’s hospitals (Nazareth Hospital and the former St. Agnes Medical Center) successfully challenged, before Judge Ludwig of the U.S. District Court for the Eastern District of Pennsylvania, the...more

Arrests Made and Investigation Underway at a Chicago Hospital

by King & Spalding on 4/23/2013

On April 16, 2013, the United States Department of Justice (DOJ) and U.S. Attorney’s Office in the Northern District of Illinois announced the arrest in Chicago of the owner and senior executive of Sacred Heart Hospital...more

Significant Proposed Changes for Federal Health Care Programs in President’s Fiscal Year 2014 Budget Plan

by Elizabeth K. Isbey, Eric Zimmerman | McDermott Will & Emery on 4/19/2013

On April 10, 2013, President Obama released his budget proposal for fiscal year (FY) 2014 (the Budget). The President reiterated his long-standing goal of reducing the deficit by $4.3 trillion over 10 years and his...more

Health Care Services Providers to Federal Health Plan Members Subject to Federal Affirmative Action Compliance Audit

by Jonathan Cain | Mintz Levin - Health Law on 4/9/2013

On March 30, the US District Court for the District of Columbia held that three University of Pittsburgh Medical Center-affiliated hospitals were federal subcontractors to an HMO that provided a managed care health plan to...more

Grassley Questions Hospital 340B Program Profits

by Ellyn L. Sternfield | Mintz Levin - Health Law on 4/5/2013

In a March 2013 article, I wrote about members of Congress calling for increased oversight of the 340B drug discount program and, in particular, hospital use of 340B drugs. This week, Senator Charles Grassley of Iowa...more

IOM Committee Releases Interim Findings on Geographic Value Index

by King & Spalding on 4/5/2013

On March 22, 2013, the Institute of Medicine Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care (IOM Committee) released an interim report analyzing a potential Medicare payment policy,...more

D.C. District Court Again Rules That Bad Debt at a Collection Agency is Allowable

by Leslie Demaree Goldsmith | Ober|Kaler on 4/4/2013

The United States District Court for the District of Columbia recently ruled, again, that a Medicare contractor is not permitted to disallow Medicare bad debts solely on the ground that the bad debt is still at an outside...more

Hospitals: Audits And Compliance

by Michael Volkov on 4/2/2013

Hospitals are under intense scrutiny. The federal government knows that one sure way to reduce healthcare costs is to get hospitals to lower their costs. Hospitals feel the pinch given the need to generate revenue but know...more

Payment Adjustments for Low-Volume Hospitals and Medicare-Dependent Hospital Program Extended

by Mark A. Stanley | Ober|Kaler on 3/30/2013

CMS has issued a notice that (1) payment adjustments for certain low-volume hospitals and (2) the Medicare-dependent hospital (MDH) program will be extended through federal fiscal year 2013 (FY 2013). The extension of the...more

CMS Revises Part B Billing Policy for Unnecessary Inpatient Admissions

by Thomas W. Coons, Carel Hedlund | Ober|Kaler on 3/29/2013

For many years, CMS policy has been that, if an inpatient admission was denied for medical necessity reasons, the hospital could bill under Part B for only a limited set of services that, significantly, did not include...more

CMS Offers Partial Concession to Hospitals by Issuing Ruling, Proposed Rule on Part B Re-Billing

by Jason Caron, Elizabeth K. Isbey, Joan Polacheck, Eric Zimmerman | McDermott Will & Emery on 3/29/2013

The U.S. Centers for Medicare & Medicaid Services (CMS) recently released both a “ruling” and a proposed rule intended to address growing concern among hospitals about billing Medicare Part B following a medical necessity...more

CMS Addresses Hospital Rebilling After Inpatient Denials Through Interim Administrator Ruling and Proposed Rule

by Darby C. Allen, B. Scott McBride | BakerHostetler on 3/22/2013

On March 18, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register two important documents addressing the hotly contested issue of a hospital's ability to obtain payment under Part B for...more

Hospitals Provided Temporary Relief In Medicare Rebilling Policy

by Madeline Engel, Renee M. Howard, David B. Robbins | Perkins Coie on 3/21/2013

The Centers for Medicare & Medicaid Services (CMS) released a ruling and an interim rule that, effective immediately, will allow hospitals to rebill certain inpatient hospital services as outpatient services for one year...more

Resubmission of Hospital Claims

by Thomas Hess, Tyler N. Williams | Dinsmore & Shohl LLP on 3/13/2013

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

CMS Announces Changes to Payment Adjustment for Low-Volume Hospitals and Medicare-Dependent Hospital Programs

by King & Spalding on 3/13/2013

In a March 7 notice, CMS announced changes to the payment adjustment for low-volume hospitals and the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems for fiscal year 2013. ...more

CMS Issues Second Set of Proposed Rule in Response to Executive Order 13563

by Emily J. Cook, Sandra DiVarco | McDermott Will & Emery on 2/21/2013

The proposed rule, issued on February 7, 2013, would make reforms to existing Medicare regulations applicable to hospitals, ambulatory surgical centers, intermediate care facilities for individuals who are intellectually...more

CMS Issues Proposed Rule to Reform "Unnecessary, Obsolete, or Excessively Burdensome" Medicare Participation Standards

by Sarah Baker, Dinetia Newman | Bradley Arant Boult Cummings LLP on 2/20/2013

On February 4, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to reform Medicare regulations that CMS views as unnecessary, obsolete, and/or excessively burdensome on hospitals and health care...more

Hospitals And Fraud Enforcement

by Michael Volkov on 2/19/2013

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

CMS Proposes Changes to Overly Burdensome Rules

by King & Spalding on 2/15/2013

On February 4, 2013, CMS proposed certain reforms to Medicare regulations that would eliminate or change rules seen as unnecessary, obsolete, or excessively burdensome on hospitals and other health care providers. The...more

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