When is a hospital not a hospital? The Fifth Circuit provided an answer in a July 29 decision in favor of a nurse seeking insurance coverage for medical treatment at a residential treatment facility. Rebecca was a nurse at North Cypress Medical Center, in Texas. Back in 2011 she was treated for an eating …
OIG Approves Lease of Employees to Psych Hospital
July 29, 2015 Leave a Comment
On July 28 the Office of Inspector General (OIG) of Health & Human Services gave its blessing to a health system’s lease of employees to a related psychiatric system. Under the arrangement the system would also provide management services. In return, the hospital would pay the system its “fully …
The RAC Wars – The Latest Shot
November 21, 2012 Leave a Comment
The latest shot in the war between hospitals and RACs has been fired. The American Hospital Association (AHA) and four hospital systems brought a lawsuit against the Department of Health and Human Services (HHS), alleging that the government’s recovery audit contractor (RAC) program improperly demands …
Supreme Court to Review Plan Reimbursement Provisions
August 14, 2012 Leave a Comment
The Supreme Court recently agreed to rule on a case that could limit the ability of plans to recover money under their reimbursement provisions. Employee benefit plans often cover the medical bills of participants, but require full reimbursement to the plan when those participants recover from third parties. Under …
The Wrinkle In Dinkel: The Departmental Appeals Board (Re)Defines the “Should Have Known” Standard for Exclusion Actions Under 1128(b)(7)
April 19, 2012 Leave a Comment
In a recent application of the Exclusion Statute, Social Security Act § 1128 et seq., the Department of Health & Human Services Departmental Appeals Board (Board) clarified that providers have an affirmative obligation to understand and correctly apply Medicare billing rules. In doing so, the Board arguably …
Reminder About Cafeteria Plan Amendments for Over-the-Counter Medications
June 24, 2011 1 Comment
As you likely know, the health care reform change to no longer allow reimbursement for non-prescription over-the-counter drugs was effective January 1, 2011. Also, special rules apply to debit cards and prescription over-the-counter medications as of January 16, 2011. Some cafeteria plans require amendments to …