The Office of Inspector General (OIG) of Health & Human Services is recommending that CMS make a major reduction to the amount it pays hospitals for certain kinds of surgery. ...more
A March 11 policy conference in Washington produced some creative thinking about the problem of high-cost specialty drugs. And on the same day, the RAND Corp. think tank released a study on the subject, “Borrowing for the...more
William Verrinder filed a False Claims Act against three of America’s biggest companies—Wal-Mart, Sears and Rite-Aid—claiming they charged Medicare for expired drugs. Since he’s a lawyer himself, he filed pro se. That way he...more
As of March 3, Solvay Pharmaceuticals is ready to second P.T. Barnum’s famous dictum that there’s no such thing as bad publicity. That’s the day a federal court in Texas dismissed a qui tam action against Solvay....more
OIG Advisory Opinion 15-03 approves a Medigap insurer’s program that, among other things, calls for (a) network hospitals to waive the deductible for Medicare enrollees, (b) the insurer to pay the hospital network a fee each...more
Remember the evil Glenn Close character in Fatal Attraction? We were sure Michael Douglas had drowned her in the bathtub, but she popped up again, still alive and scary as all get-out.
Class actions by uninsured...more
You read that correctly: the hospital fired the physician who did the reviewing in a medical staff peer review proceeding. Hospital executives present at the proceeding felt the reviewing physician was too harsh in...more
Sir Arthur Conan Doyle might have called it “The Case of the Doctors Who Work More than 24 Hours a Day.” Unfortunately for the physician group in question, Sir Arthur wasn’t the author; the federal court for the Northern...more
If you think of CMS quality ratings as the Dow Jones index, then last Friday, February 20, was the equivalent of Black Tuesday, October 29, 1929, the day the stock market collapsed. Why? ...more
Here’s a nightmare. An arbitrator rules against your hospital for failing to honor an agreement to refer Medicare patients to a home health agency. Why? Because the home health agency paid your hospital good money for the...more
In the health care industry the line between attorneys and risk managers is often blurred. That’s only natural because a key duty of risk management is to avoid and mitigate legal liability. And it’s increasingly common for...more
The federal Anti-Kickback Statute makes it a crime to give or receive anything of value in return for “referral” of a Medicare patient. But exactly what is a “referral”? That’s the issue decided by the Seventh Circuit last...more
On January 16, 2015, the Cayman Islands published new insurance regulations affecting portfolio insurance companies (PICs). The regulations are designed to provide more flexibility to insurance companies incorporated as...more
The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services. In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider...more
Okay, it wasn’t really Rip Van Winkle. Rip slept for only twenty years. It was Dr. Legrand Belnap who sued a Salt Lake City hospital and its medical executive committee members. ...more
Last week a federal court in Florida granted a radiology practice’s motion for judgment in its favor in a False Claims Act case, despite these formidable obstacles: (1) the practice had billed Medicare for services performed...more
Sometimes doing the right thing for the right reason can be costly. Last week it cost nonprofit Via Christi Regional Medical Center $59 million....more
It took three years for Massachusetts hospital giant Partners HealthCare System to negotiate the state attorney general’s approval of its plan to acquire three more hospitals to add to its current 12. But last Thursday a...more
Last week the South Carolina Supreme Court issued an opinion addressing the issue whether an indemnification claim is subject to that state’s medical malpractice statute of limitations, when the claim is for recovery of a...more
Remember Bill Clinton’s 1992 campaign mantra, “It’s the economy, stupid!” A study released today by the Robert Wood Johnson Foundation indicates those four words are the best answer to the question, “Why are so many...more
When the Affordable Care Act (ACA) was signed into law back in 2010, it directed the Centers for Medicare & Medicaid Services (CMS) to establish the Consumer Operated & Oriented Program (CO-OP). The point of the CO-OP is to...more
On January 26, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a news release reporting Health & Human Services (HHS) Secretary Sylvia Burwell’s announcement earlier in the day of measurable goals and a...more
Some questions can’t be answered in a vacuum. That’s the situation when the question is whether an entity wants to be part of the state or separate from it. If the specific issue is whether its board meetings are open to...more
In a move designed to stretch budget dollars and spread the research wealth, the National Institute of General Medical Sciences (NIGMS) announced last week that starting next year, it will impose a one-grant-at-a-time policy...more
Ever face the choice between trading in your old car or paying for multiple repairs? CMS faced that kind of choice with its Recovery Audit Contractor (RAC) program. Under the RAC program, contract auditors audit hospitals...more