Medicare

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

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

by Stephen Azia, Danielle Trostorff | Baker, Donelson, Bearman, Caldwell &... on 5/13/2013

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled "Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment" on April 29, 2013. This proposed rule,...more

HHS OIG Issues Report on Hospice General Inpatient Care Billing

by Howard Young | Morgan Lewis on 5/9/2013

Report makes no formal recommendations, but OIG notes that lengths of stay and frequency of general inpatient care are issues requiring further scrutiny....more

CMS Issues Proposed Hospice Payment Update for FY 2014

by King & Spalding on 5/9/2013

On April 29, 2013, CMS issued a proposed rule providing the payment rates and wage index for hospices effective FY 2014. While the proposed rule describes current findings and offers options for consideration, it does not...more

Health Care Reform Update -- May 6, 2013

by Joseph P. Hammang, Alexander Hecht, Abby Matousek, Jeremy Rabinovitz | Mintz Levin - Health Law on 5/8/2013

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 Scheduled....more

Mcnees Insights - Asset Planning and Federal Taxation - Spring 2013

by Vance E. Antonacci, Scott Alan Mitchell | McNees Wallace & Nurick LLC on 5/8/2013

In This Issue: ATRA 2012 – How Does it Affect You?; Planning and Paying for Long-Term Care; and Obama Revenue Raising Proposals. Excerpt from ATRA 2012 – How Does it Affect You?: The American Taxpayer...more

Gray Divorce: Social Security and Medicare

by Andrea Dunbar, Nancy Van Tine | Burns & Levinson LLP on 5/7/2013

Gray divorce is on the increase. As Boomers age they are deciding to divorce. There are a number of issues that are of particular importance. My very talented colleague Andrea Dunbar has written today about Social Security...more

Phase Two Edits - Temporarily on Hold

by Donna Senft | Ober|Kaler on 5/3/2013

In its April 25, 2013 Medicare FFS Provider e-News, CMS announced that due to “technical issues” it would be delaying the implementation of the Phase 2 claims edits. ...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

CMS Proposes Additional Incentives to Reduce Medicare Fraud Including Increase to Reward for Reporting Fraud

by King & Spalding on 5/1/2013

On April 24, 2013, CMS issued a proposed rule that would further incentivize Medicare beneficiaries and other individuals to report suspected Medicare fraud under the Medicare Incentive Reward Program. CMS is proposing to...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

CMS Aims to Grease the Reporting Wheels for Medicare Fraud and Abuse

by Daniele Capasso, Charles Cohen, Howard Young | Morgan Lewis on 4/30/2013

Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority. On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more

Sixth Circuit in MedQuest: No FCA Liability for Violation of Medicare Conditions of Participation Without Violation of Conditions...

by Calvin Marshall | Chambliss, Bahner & Stophel, P.C. on 4/26/2013

On April 1, 2013, the U.S. Court of Appeals for the Sixth Circuit overturned an $11.1 million False Claims Act (FCA) judgment by the U.S. District Court for the Middle District of Tennessee against MedQuest Associates, Inc.,...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

Home

Legal News

Find a Lawyer

Browse Subjects

Subscribe

Pro Services

For Reporters