Articles and Blogs

CMS Makes Changes to RAC Program Processes On November 6, CMS announced that the number of medical records a recovery audit contractor (“RAC”) can request from health care providers to support audits is 0.5 percent of a facility’s total amount of paid Medicare claims from the previous year. Currently, the limit on the amount of documents…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) issued a report in June1 that is the equivalent of a “strongly worded letter” to the Centers for Medicare & Medicaid Services (“CMS”) for not implementing OIG’s past recommendations to prevent and combat fraud in the Medicare Part D Program (“Program”).  In July, Ann…Read More

The U.S. Department of Justice (“DOJ”) recently announced a $2.3 million settlement1 with a Hospital in Massachusetts (“Hospital”) to resolve allegations of Hospital’s failure to provide controls and safeguards against controlled substance diversion in violation of the Controlled Substances Act (“CSA”).2 According to the DOJ’s press release, this is the largest settlement related to drug…Read More

CMS Issues Final Regulations for Stark Law Modifications Late on October 30, CMS issued the CY 2016 Physician Payment final rule. The comprehensive rule provides clarification and establishes two new exceptions to the Stark Law in regards to the Self-Referral Disclosure Protocol, which should ease the compliance burden for hospitals. The compliance revisions in the…Read More

Last week, CMS promulgated a final rule that creates a new “timeshare license” exception to the Stark Law. A few days ago, we reported on this and other changes here but believe that the timeshare topic merits additional discussion. The new exception was created due to the difficulty hospitals and physicians experience when trying to…Read More

Executive Summary On November 2, 2015, the Office of Inspector General (“OIG”) published its Work Plan for Fiscal Year (“FY”) 2016 (“Plan”).  The Plan, which is published annually and describes OIG’s new and ongoing audit and enforcement priorities for the upcoming year, is helpful in identifying corporate compliance risk areas and providing focus for providers’…Read More

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 15-13,1 which provided a favorable opinion of a health system’s (“Requestor’s”) proposed arrangement to offer free transportation services to patients in a rural community (“Arrangement”). OIG stated that it would not impose sanctions against Requestor for violations of the Civil…Read More

A trend in real estate-related False Claims Act litigation should put hospitals and other health care providers on notice that relators are looking for big paydays for non-compliant real estate arrangements. The relators described in this article are real estate professionals who are bringing technically complex claims with little to no institutional knowledge of the…Read More

Last week, Congress passed the Bipartisan Budget Act of 2015 (“Budget”), and President Obama signed the Budget into law on November 2, 2015.  Among many other changes, the Budget includes an impending exclusion on hospital coverage for off-campus hospital outpatient departments that first bill for services on or after November 2, 2015.  Even though site-neutral payment proposals…Read More

On Thursday, October 29, 2015, CMS issued the pre-publication copy of the final home health PPS rule for CY 2016 (“the Rule”).  The Rule adopts most of the proposals from July but makes a few key changes. Rates, Payments and Home Health Spending Although CMS makes several key changes to the final rule, CMS projects…Read More