Heed Caution: Takeaways From the OIG's Advance Care Planning Report
Surprise! What Hospices Need to Know About the No Surprises Act
Medical Device Manufacturer THD Pays $700,000 to Resolve FCA Allegations - On September 6, the US Attorney’s Office for the District of Maryland announced that THD America, Inc., and its parent company, THD SpA of Italy,...more
On August 26, 2024, the United States Attorney’s Office for the District of Montana filed a False Claims Act (FCA) complaint against a Montana oncologist, alleging that the oncologist’s busy schedule led to excessive claims...more
In the proposed CY 2025 Physician Fee Schedule (PFS) published in the Federal Register on July 31, the Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposal to revise the Medicare Claims...more
Taylor v. State of Delaware, 2024 WL 1209292 (Del. Super. Mar. 21, 2024) - Ms. Taylor injured her right wrist in 2016 while working as a teacher for the State. Her injury eventually developed into complex regional pain...more
The major calendar year proposed regs are now out, with thousands of pages of text to digest. Since a plethora of issues are embedded in these regs, including the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) and the...more
True to their word in several recent public statements, the Chief and Deputy Chief of the Medicaid Fraud Division of the Massachusetts Attorney General's Office have brought several recent criminal cases against dentists for...more
Split (or shared) visits—the current term used by the Center for Medicare & Medicaid Services (CMS)—allow non-physician practitioners (NPPs) and physicians who work for the same employer/entity to share patient visits on the...more
In its December 18, 2023, Enforcement listserv notice, HHS’s Office of Inspector General (“OIG”) published its Work Plan Updates for December. Although six updates were published, this article will only highlight the...more
On November 29, 2023, the Centers for Medicare & Medicaid Services (CMS) published the 2024 annual update to the designated health services (DHS) Code List. This annual update includes important changes for Medicare providers...more
Get ready to be inspired with game-changing insights and industry connections! For over two and a half decades, healthcare compliance professionals have gathered at HCCA’s Compliance Institute (CI) to share ideas, learn...more
In recent years, the Centers for Medicare & Medicaid Services (CMS) has expanded payment for remote monitoring services in an effort to pay for non-face-to-face services that improve care coordination for Medicare...more
On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized new policies related to remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services reimbursed under the Medicare...more
On September 20, 2023, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) announced the Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee...more
Physicians, hospitals, and healthcare providers: have you updated your billing practices? As of September, any individual or facility licensed or certified to provide healthcare services in Texas must provide an itemized...more
Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •Montana AG Mounts Defense of State’s TikTok Ban- •DC AG...more
Evaluation and management (E/M) services have been called “the core” of healthcare billing. E/M is a catch-all claim, allowing medical professionals to bill for diagnosing or treating nearly any illness or injury. E/M is also...more
A consistent pattern emerges in data breach and cyber-attack cases when companies turn to their insurers for coverage after such incidents. Whether they possess specialized cyber insurance or not, insurers often decline...more
Corporate compliance programs in the healthcare industry include many of the same elements that we are all familiar with – risk assessments, code of ethics, written policies and procedures, comprehensive training...more
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reported in November 2022 that many providers are not complying with Medicare’s billing rules for advance care planning services. In large...more
Bass, Berry & Sims attorney Shannon Wiley, with Carine Leslie and Katie Garmon of PYA, P.C., recently discussed the complexities associated with billing, coding, and collecting for infusion services as part of the Infusion...more
On January 18, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Memorandum to all state survey agency directors addressing erroneous schizophrenia coding and increased transparency of Nursing Home Care...more
Healthcare organizations collect and generate tremendous volumes of highly sensitive—and highly regulated—information about patients every day. A substantial portion of this data is personally identifiable information (PII)...more
While direct patient billing may be less common for hospice patients than for patients receiving hospital or other types of care, there are aspects of the No Surprises Act and its implementing regulations that are important...more
On January 4, 2023, the Department of Justice issued a press release stating that Jet Medical Inc. has agreed to pay $200,000 to resolve criminal allegations relating to a migraine headache treatment. Jet Medical and two...more
Medical Device Company to Pay Over $700,000 To Resolve Criminal Allegations - On January 4, 2023, a criminal information was filed in the Southern District of Illinois, in which Jet Medical Inc. (Jet), a medical device...more