Managing Malpractice in Medicare’s Never-Never Land

Some things just aren't supposed to happen. In health care, they are referred to as "never events" and include hospital-acquired infections or injuries, medication errors and objects left inside patients during surgery. Yikes. The Centers for Medicare and Medicaid Services (CMS) have...

Must Employers Carry Medicare Eligible Active Employees and Spouses?

by Keisha N. Jackson As health care costs continue to rise, many employers are considering creative solutions for keeping costs low without drastically changing the benefits offered to active employees. Active employees who have spouses on Medicare or who are themselves eligible for Medicare may...

Immigrants Create Medicare Surplus: Study

" Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending. The study , led by researchers at Harvard...

Ambulatory Surgery Centers: Rapid Growth and Lack of Oversight in California

By John Stahl, Esq. Concern regarding the relatively little public information about heavily utilized ambulatory surgery centers (ASCs) in California prompted the California HealthCare Foundation (Foundation) to research ownership statistics and other data regarding these facilities that service rapidly...

Williams Mullen: 4th Circuit Upholds Lengthy 'Stent' for Interventional Cardiologist

By John Staige Davis V Can a cardiologist be sent to prison for performing medically unnecessary stent procedures, even though he stented a considerably lower percentage of his patients than his peers? In United States v. McLean, No. 11-5130 (Apr. 23, 2013) ) [lexis.com subscribers may access the...

Johnson & Johnson, 2 Units Plead Guilty, Pay $2.2 Billion In Criminal, Civil Penalties

WASHINGTON, D.C. — (Mealey’s) Two Johnson & Johnson subsidiaries have pleaded guilty, and the parent company and two subsidiaries will pay $2.2 billion in criminal fines, civil penalties and forfeitures in one criminal and several civil cases for off-label marketing of three drugs, for...

Williams Mullen Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For ‘Incident To” Services Means For Medicare Providers

By Brian C. Vick In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies on reimbursement revenue from these...

Bradley J. Frigon on the Applicability of Medicare Secondary Payment Subrogation Rights to Medicare Part C and Part D Private Carriers

By Bradley J. Frigon Following several cases that challenged federal regulations, CMS published a memorandum to all Medicare Advantage Organizations and Prescription Drug Plan Sponsors regarding Medicare Secondary Payment Subrogation Rights for Part C and Part D private carriers seeking reimbursement...

Landmark Jimmo v. Sebelius Settlement Helps Medicare Patients Receive Skilled Care

By Morris Klein CELA CAP | Settlement of a class-action suit filed against HHS makes it easier for patients to continue to receive skilled care services; the settlement removes clandestine policies requiring Medicare patients to exhibit improvement to continue receiving such services. Medicare will...

U.S. High Court Hears Oral Arguments In Dispute Over Taxing Severance Payments

WASHINGTON, D.C. — (Mealey’s) Severance payments fall within the Federal Insurance Contributions Act’s (FICA) definition of wages and are taxable, Assistant to the Solicitor General Eric J. Feigin told the U.S. Supreme Court Jan. 14 in arguments presented on behalf of the United States...

Norton Rose Fulbright: OIG Releases FY 2014Work Plan Summary

By Frederick Robinson , Megan Fanale Engel , Cori Annapolen Goldberg and Selina Coleman On January 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published its Work Plan for fiscal year 2014. The OIG announced that in the upcoming year, it will continue...

Williams Mullen: OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare

By Marcus C. Hewitt H.H.S’s Office of Inspector General’s yearly work plan was issued on January 31, 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review Medicare payments to hospitals for outpatient evaluation...

Williams Mullen: OIG 2014 Work Plan Focuses On Compounded Pharmaceuticals Reimbursed By Medicare

By Brian C. Vick The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) included two items in its recently-released 2014 Work Plan indicating a new focus on the quality and safety of compounded pharmaceuticals reimbursed by Medicare. Pharmaceutical...

Barnes & Thornburg LLP: OIG Work Plan 2014: Takeaways for Hospitals

By Gayland Hethcoat With the release of its work plan for fiscal year 2014 on Jan. 31, 2013, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has provided insight on the agency’s current enforcement priorities in Medicare, Medicaid, and other HHS programs...

Norton Rose Fulbright: CMS Offers New Resources and Guidance on 2-Phase Approach to Sunshine Act Reporting

By: Benjamin Koplin , Selina Coleman and R. Jeffrey Layne The Centers for Medicare & Medicaid Services (CMS) has posted new resources to its "Open Payments" website to clarify its recently announced two-stage approach to registration and data submission. These resources include: ...

Barnes & Thornburg LLP: President Obama Signs Bill Extending Physician Medicare Rates And Delaying ICD-10 And RAC Audits Under The 2-Midnights Rule

By Nita Garg On April 1, President Obama signed the Protecting Access to Medicare Act of 2014. This legislation extends current Medicare physician reimbursement rates and delays implementation of the ICD-10 code for a full year. Previously, hospitals were to be ICD-10 compliant by October 1, 2014;...

Steptoe & Johnson PLLC: False Billing Leads To Record Settlement In Medicare/Medicaid Fraud Case

The United States Attorney for the Southern District of West Virginia has announced a record $4.675 million settlement with a medical lab for false billings to Medicare and to West Virginia Medicaid. R. Booth Goodwin, of Charleston, WV, said in his press release that Calloway Laboratories of Woburn,...

Williams Mullen: CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans

By Brian C. Vick O n April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision with significant future implications for sponsors...

State Net Capitol Journal – June 23, 2014; Federal Highway Trust Fund Running On Fumes

Budget & Taxes FEDERAL HIGHWAY TRUST FUND RUNNING ON FUMES: For quite some time, state and local transportation officials have been anxiously watching the federal highway trust fund shrink and waiting for Congress to do something about it. "We've seen it coming like a slow-motion train...

Jail for False Health Insurance Claims – Health Insurance Fraud Conviction Stands

Because Medicare and Medicaid pay health care providers promptly and without any inquiry into the probity of the claim health insurance fraud is a fairly easy crime to commit with little chance of being arrested or convicted. Perhaps that is the reason why the extent of health insurance fraud is counted...

Staying Covered: How Immigrants Have Prolonged the Solvency of One of Medicare’s Key Trust Funds and Subsidized Care for U.S. Seniors

"The Partnership for a New American Economy’s new report, Staying Covered: How Immigrants Have Prolonged the Solvency of One of Medicare’s Key Trust Funds and Subsidized Care for U.S. Seniors , shows that immigrants are key contributors to Medicare’s Hospital Insurance Trust Fund...

Foley & Lardner LLP: 8th Circuit Dismisses Whistleblower's Suit Finding Facts Were Already Publicly Disclosed

By Jacqueline N. Acosta In an August 7, 2014 opinion, the Eighth Circuit upheld the dismissal of a whistleblower’s suit alleging that a number of pain pump device makers had violated the False Claims Act (FCA) by marketing their pain pumps for harmful off-label uses. United States ex rel. Paulos...

Norton Rose Fulbright: Physicians Payments Sunshine Act Data 33 Percent Unpublishable, Penalties Next?

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician Payments Sunshine Act website is still expected...

Norton Rose Fulbright: CMS Offers Settlement Of Inpatient RAC Denials

By Mark Faccenda On August 29, 2014, the Centers for Medicare and Medicaid Services (“ CMS ”) announced that certain providers with pending appeals of specified inpatient-status claims denied by Medicare contractors may elect to receive partial payment on those claims in exchange for the...

Thank Heaven for Little Girls….. and “Clean Claims” in Delaware

This comes to us from Christopher Logullo of Chrissinger & Baumberger, also known as in-house counsel for Liberty Mutual. I had commented recently about how I love hearing from counsel regarding their cases and more importantly, their take on the Board’s ruling and for a second time this week...