The Sixth Circuit brought a refreshing sense of reality to the government’s sometimes unreal calculation of damages in False Claims Act (FCA) cases. In this case the government had sought, and won at the trial level, an award of $763,000 against a contractor because of a subcontractor’s underpayment of …
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 …
Criminal Conviction Leaves Defendant Defenseless in FCA Civil Action
February 2, 2016 Leave a Comment
Pity Dr. Christina Clardy. In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution. Then in 2014 the government added Christina as a defendant in its pending False Claims Act (FCA) civil action against her cronies in the physical …
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 …
New Rule Permits Hospitals to Subsidize Physician Employees
November 9, 2015 Leave a Comment
A new 2016 Medicare physician payment rule allows hospitals and other provider institutions to make payments to physicians for the purpose of enabling them to employ nonphysician practitioners, such as nurse practitioners and physician assistants. This is an exception to the general Stark Law prohibition on …
A Recap of National Health IT Week
October 12, 2015 Leave a Comment
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 …