Articles and Blogs

Lawmakers Continue Push for SGR Deal in Lame Duck More than 110 members of Congress, including the GOP Doctors Caucus, are urging House leadership to repeal and replace Medicare’s Sustainable Growth Rate (“SGR”) formula for physician payment before Congress adjourns in December. With House Ways and Means Chairman Dave Camp (R-MI) retiring at the end…Read More

Under both the Stark Law and the Anti-Kickback Statute, space lease arrangements between referring physicians and hospitals are coming under growing scrutiny as the government’s concentration on eliminating Medicare and Medicaid fraud and overpayments increases. Safe harbors and exceptions with respect to lease arrangements exist under both statutes with one of the requirements being that…Read More

Relator Thulin was a pharmacist in Idaho working for Shopko, a Wisconsin company. He filed an FCA claim alleging Shopko defrauded Medicaid by failing to pass along private insurance plan prices to Medicaid for dual-eligible patients. The court rejected Shopko’s claim, affirming the trial court’s grant of a motion to dismiss. Dual-eligible Medicaid recipients are…Read More

On November 10, 2014, the Centers for Medicare & Medicaid Services (“CMS”) published the amended final rule regarding the expansion exception process for physician-owned hospitals (“2015 Final Rule”).  The 2015 Final Rule will take effect on January 1, 2015. Background Under the Affordable Care Act’s (“ACA’s”) amendments to the Stark Law, a physician-owned hospital cannot…Read More

Republican Election Victories Mean Changes for Health Care The results of the November 4 midterm elections have given Republicans on Capitol Hill control of the Senate and their largest majority of the House since 1932.  Senate Republicans gained seven seats and should increase that number once races in Alaska and Louisiana are official. In Alaska,…Read More

The four-year battle over Indiana’s Right-to-Work Law came to a close on November 6, 2014 when the Indiana Supreme Court issued its unanimous 5 – 0 decision upholding the constitutionality of the law passed by the General Assembly amid union protests in 2012.  See our blog Right-to-Work: Now There are Twenty Three that discusses the history of…Read More

CMS recently released the display copy of the OPPS/ASC Final Rule for CY 2015 which finalizes proposals related to the reporting of services provided in hospital off-campus provider-based departments (“PBDs”).  The Final Rule can be found here. The changes require hospitals to identify services provided in off-campus PBDs through use of a new HCPCS code…Read More

Executive Summary On October 31, 2014, the Office of Inspector General (“OIG”) published its Work Plan (“Plan”) for Fiscal Year (“FY”) 2015.  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 provider compliance risk areas and providing focus for their…Read More

On October 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) released the Work Plan for Fiscal Year 2015 (“Work Plan”). The Work Plan confirms OIG will continue to concentrate a great deal of their enforcement efforts on the security and vulnerabilities of protected health information (“PHI”) contained in…Read More

On October 31, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final notice approving Lake Pointe Medical Center’s (“Lake Pointe”) request for an exception to the Affordable Care Act’s (“ACA’s”) expansion limitations imposed on physician-owned hospitals. Background Under the ACA’s amendments to the Stark Law, a physician-owned hospital cannot expand the aggregate…Read More