On July 7 CMS issued a proposed rule reaffirming its position that the Stark Law prohibits “per-click” rent payments when the lessor is the one referring the patients to the lessee for the “click,” e.g., the test or procedure. Say, for example, a physician leases an X-ray machine to an imaging center. …
And You Thought RAC Audits Couldn’t Get Any Worse
May 24, 2016 Leave a Comment
If there’s one thing that unites the hospital industry—even the fiercest competitors—it’s hatred of audits by recovery audit contractors, or RACs. Why? For one thing, because RACs operate on a contingency fee basis. They get to keep a portion of the fees they force providers to repay. It’s as …
Court Rejects End-Run of Medicare Appeals Rules
April 8, 2016 Leave a Comment
The Indiana Health Department sent a team to the Nightingale home health care and hospice group, in response to complaints. When CMS received the team’s report, it notified Nightingale that its Medicare certification was being terminated. Nightingale filed a federal lawsuit against the Secretary of Health …
Finally, A Final Rule on ACA’s 60-Day Repayment Rule
February 12, 2016 Leave a Comment
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 …
Was Whistleblowing a Reason for Firing or the Reason?
January 26, 2016 Leave a Comment
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 …
GAO Report Says Hospital-Physician Consolidation Requires Payment Reform
December 23, 2015 Leave a Comment
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 …