Bill Clinton was President when Congress enacted a law requiring CMS to come up with qualifications for those who make or supply artificial limbs to Medicare patients. It was January 11, 2017, when CMS finally unveiled the proposed qualifications. And, having taken over 16 years to produce the proposal, CMS …
Do CMS Ratings Punish Hospitals for Serving the Poor?
September 23, 2016 Leave a Comment
Does the CMS star rating system reward hospitals for serving the affluent and punish those that serve the poor? The answer is a resounding yes, according to a recently published analysis by Bloomberg BNA. The analysis compared star ratings of hospitals across the country with U.S. Census Bureau data for each …
The Law Doesn’t Forbid Submitting False Claims
August 24, 2016 Leave a Comment
An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims. That made all the difference in an appeal of summary judgment in favor of a physician group that, according to the relator, failed to comply with …
Same Per-Click Rule, New Rationale
July 12, 2016 Leave a Comment
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 …