Some Members of Congress Question Annual Limit Waivers

HHS has already granted waivers from the new restricted annual dollar limits to 30 companies—and some members of Congress want an explanation why, according to a recent letter to HHS from the House Committee on Energy and Commerce. As previously discussed, HHS has regulatory authority to waive the restricted …

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Exercise Caution When Looking for the Cause of an Adverse Outcome

Independent Probe Findings Not Protected by Quality Management Privilege A federal district court recently held that the Colorado statutory privilege for quality management information did not protect an investigation conducted by the attending surgeon outside the scope of the hospital’s quality management …

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What the OIG Guidance on Permissive Exclusion Means for Owners and Managers

For quite some time, the Office of Inspector General (OIG) has had the authority to exclude an owner, officer and/or manager of an entity convicted of certain criminal offenses or that is excluded from participation in Federal health care programs. In section 6502 of the Patient Protection and Affordable Care Act …

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Minnesota Department of Revenue Guidance on State Tax Non-Conformity

Prior to the passage of health care reform legislation, the value of employer-provided health benefits to the children of employees was treated as taxable income if such children did not qualify as “tax dependents” under the Internal Revenue Code. However, health care reform legislation now excludes from …

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OIG Intends to Exclude Officers and Managing Employees of Sanctioned Entities: Limited Safety Zones

On October 20, 2010, the OIG released a notice setting forth non-binding factors the OIG will consider in assessing whether to impose permissive exclusion in accordance with section 1128(b)(15)(A)(ii) of the Social Security Act, which authorizes the OIG to exclude any officer or managing employee of a sanctioned …

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OIG Approves Limited Insurance Pre-Authorization Services

On September 28, 2010, the OIG released Advisory Opinion No. 10-20, which permits a physician-owned imaging center to offer free insurance pre-authorization services for its own services. Of course, before the OIG begins its analysis, it states that the OIG’s position on arrangements where goods or services are …

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