News & Analysis as of

Physicians Medicare

Sixth Circuit: Technical Physician Signature Deficiencies not "Material" to Reimbursement Claims

by Jones Day on

The District Court for the Middle District of Tennessee held on June 22, 2017, that the timing requirements related to a physician's certification of need for home health services were not "material" to the Centers for...more

West Virginia Doctor Secures Temporary Restraining Order Against Medicare Exclusion

by Tucker Arensberg, P.C. on

In Robie v. Price, Dr. Robie successfully obtained a temporary restraining order prohibiting CMS from terminating his Medicare billing privileges prior to the exhaustion of his administrative remedies by the U.S. District...more

CMS Proposes Medicare Physician Fee Schedule Update for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published its proposed rule to update the Medicare physician fee schedule (PFS) for calendar year (CY) 2018. The proposed rule addresses numerous Medicare policies,...more

Client Alert: Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante...more

Nationwide Healthcare Prosecutions Targeting an Array of Practices . . . Is "Just The Beginning"

by Bracewell LLP on

On July 13, 2017, the Department of Justice ("DOJ"), in conjunction with the Department of Health and Human Services ("HHS"), continued its annual tradition of coordinating the filing of charges and sweeping arrests in...more

CMS’s 2018 Medicare Physician Fee Schedule Proposed Rule Would Slash Non-Excepted Provider-Based Department Payments

by Dorsey & Whitney LLP on

The Centers for Medicare & Medicaid Services (CMS) released its 2018 Medicare Physician Fee Schedule proposed rule on July 13, 2017. The proposed rule, among other things, proposes to cut Medicare payments for services...more

Amounts Billed Do Not Indicate Fair Market Value In FCA Case

by Reed Smith on

Our day job has been keeping us busy, so busy with depositions, motions, delayed flights, and assorted drama that we have not posted in more than a month. After such a long layoff, we had hoped to return with a vengeance, a...more

Medicare Proposes Continued Relief for Critical Access and Rural Hospitals Through 2-Year Moratorium on Direct Supervision...

by Dorsey & Whitney LLP on

On July 13, 2017, CMS released a proposed rule as part of its 2018 Outpatient Prospective Payment System proposals that is aimed at helping to reduce some of the burdens rural hospitals experience in recruiting physicians....more

CMS Releases Proposed Rule for 2018 Physician Fee Schedule

by King & Spalding on

On July 13, 2017, CMS proposed a rule (Proposed Rule) updating payment policies and rates, as well as the quality provisions, for the Medicare Physician Fee Schedule (PFS). Among other provisions, the Proposed Rule reduces...more

Payor Initiatives with Physicians and Payment Models In The Insurance Marketplace

by Locke Lord LLP on

Payment models that seek to reward physicians, hospitals and other health care providers for achieving certain quality and cost-saving goals, or “value-based purchasing” (VBP), are not new to the healthcare landscape,...more

Achievements You Don’t List on Your Resume

by Faegre Baker Daniels on

A physician immigrated to the United States in 1991 and established a medical practice called Compassionate Doctors. By 2013 the practice and its related health care entities boasted some 44 employees and contractors,...more

Court Overreaches in Requiring Medical Necessity Determination by Labs

by Jones Day on

On June 9, 2017, the U.S. District Court for the District of Columbia denied a motion to dismiss brought by a laboratory in U.S. ex rel. Groat v. Boston Heart Diagnostics Corp., 2017 WL 2533341. Part of the grounds for...more

More Small Physician Practices May Become Exempt From MACRA

by Fox Rothschild LLP on

On June 20, 2017, The Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule which would exempt a greater number of small practices from complying with the Medicare Access and CHIP Reauthorization Act of...more

Sixth Circuit Court of Appeals Affirms Offset of Medicare Reimbursement by DSH Payments Received

by Farrell Fritz, P.C. on

On June 14, 2017, the Sixth Circuit Court of Appeals in Breckinridge Health, Inc., et al. v. Price affirmed the district court’s finding that HHS could offset the amount of a hospital’s Medicare reimbursement by the Medicaid...more

Value-based health care: fraud & abuse laws

by Ropes & Gray LLP on

Michael Lampert, Ropes & Gray health care partner, discusses fraud and abuse law application to value-based health care arrangements. __ Much has been made about how the fraud and abuse laws, which were designed in order...more

OIG Reports More Than $731 Million in Inappropriate Medicare Meaningful Use Payments

by McDermott Will & Emery on

The Electronic Health Records (EHR) Incentive Program run by Centers for Medicare and Medicaid Services (CMS) garnered attention again last week following the release of a report by the Office of Inspector General of the US...more

Court Puts the Brakes on Whistleblower's FCA Parking Claims

by Baker Ober Health Law on

The Department of Justice (DOJ) reports that, in fiscal year 2016 ending September 30, it obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims. More than half of this...more

Are you subject to MIPS reporting requirements in 2017?

by Thompson Coburn LLP on

The Centers for Medicare and Medicaid Services (“CMS”) announced in late April that they anticipated notifying eligible clinicians about their Merit-based Incentive Payment System (“MIPS”) participation status for 2017 via...more

Proposed Telehealth Expansion of Medicare Reimbursement

by Baker Ober Health Law on

Telehealth continues to be a frontrunner on one strategy to achieve the triple aim, an effort to improve patient experience, population health and reduce per capita cost. To date, government reimbursement for telehealth...more

Senate reintroduces resident rotator legislation, other GME-related Washington updates

by Dentons on

With the recent change of administration and a new congressional session beginning in 2017, medical education stakeholders have been watching closely for any signs on the political horizon regarding federal GME funding. Below...more

CMS changes the SRDP process effective June 1, 2017

by Thompson Coburn LLP on

If you are in the process of drafting a SRDP submission, you must use the new SRDP forms or risk CMS not accepting the disclosure into the protocol. Effective June 1, 2017, the Centers for Medicare and Medicaid Services’...more

Thinking of Becoming a Concierge Practice? Some Legal Issues to Consider

Many primary care physicians are transitioning their practices to a “concierge” model, sometimes called “Direct Primary Care” or “Retainer” practice. In a concierge practice, patients pay a fixed annual or monthly fee to...more

Health Care E-Note - May 2017

by Burr & Forman on

When a physician leaves a medical practice, especially if the physician stays in the area to compete against his/her former employer, the situation can become stressful and acrimonious. Please see full E-Note below for...more

Changes in MACRA Creating Complications in Healthcare

by Clark Hill PLC on

Healthcare is still buzzing about CMS’s Medicare physician two-track payment system, MACRA. The Merit-Based Incentive Payment System (MIPS) is a complex pay-for-performance system based on traditional fee-for-service (FFS)....more

FCA Issues to Watch: FCA Claims Concerning Physician Compensation

by Bass, Berry & Sims PLC on

Physician employment arrangements with hospitals have remained a significant area of regulatory scrutiny in recent months with the announcement of several high profile settlements and decisions in key FCA cases involving...more

398 Results
|
View per page
Page: of 16
Cybersecurity

"My best business intelligence,
in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.