Finally, A Final Rule on ACA’s 60-Day Repayment Rule

On February 11, 2016, CMS released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA) established the 60-day deadline for returning Medicare and Medicaid overpayments.  The clock started running from the time an overpayment …

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Was Whistleblowing a Reason for Firing or the Reason?

The outcome of a physician whistleblower’s retaliation claim against his former medical group turns on the question whether whistleblowing was a reason or the reason he was fired.  If it was a reason, he loses.  If it was the reason, he wins. Dr. Donald Helfer was an anesthesiologist and shareholder with …

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GAO Report Says Hospital-Physician Consolidation Requires Payment Reform

Yesterday the Government Accountability Office (GAO) requested that Congress order Health & Human Services to equalize Medicare payments for the same services, whether provided in a physician office or in a hospital outpatient department (HOPD). The report focuses on the ever-increasing consolidation of …

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A Recap of National Health IT Week

National Health IT Week wrapped up on Friday.  This may have been the most eventful week in the ten year history of the event, which is organized by the Health Information Management Systems Society (HIMSS).  Below are a few of the highlights (each of which could likely carry its own blog post): Stage 3 …

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Two More Hospitals Qualify for Exception to Exception to Grandfather Exception to Elimination of Whole Hospital Exception to Stark Law Prohibition

The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest.  There used to be a “whole hospital exception” excluding entire hospitals (as contrasted to departments or parts of hospitals) from the prohibition. The …

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Brace Yourself for another Round of Death Panel Debate

Remember the notorious “death panel” debate of 2009?  Congress was considering a proposal to pay doctors for end-of-life counseling.  Former vice presidential candidate Sarah Palin led the attack on the proposal, claiming that “death panels” would decide who lived and who died.  Many conservatives …

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