This week, the Office of Inspector General (OIG) issued OIG Advisory Opinion No. 15-15 regarding a proposed arrangement in which a hospital would bill a radiology group for transcription of
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Fraud and Abuse
Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider
By Edward J. Cyran on
Commercial payors are actively looking for ways to reduce payments to out-of-network providers. One area of focus is discounts and waivers of patient copayments and deductibles by out-of-network providers. In…
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Avoiding Insider Trading Liability
By Edward J. Cyran on
A new article in the online journal, JAMA Internal Medicine, highlights the importance for physicians of keeping valuable non-public information confidential. Under insider trading laws, it is illegal for anyone…
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First Court Decision on the Medicare/Medicaid 60-day Overpayment Rule
By Edward J. Cyran on
You may have heard some years ago that the Affordable Care Act established a “60-day overpayment rule” that requires a provider to report and return any overpayment from a federal…
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Office of Inspector General Advisory Opinion Addresses Hospital Management Services
By Todd Rodriguez on
The Office of Inspector General (OIG) of the Department of Health and Human Services posted an Advisory Opinion today addressing a hospital system’s proposal to lease administrative employees and to…
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Federal Fraud and Abuse Laws Apply to Medicare Advantage Too
By Todd Rodriguez on
Many physicians mistakenly believe that federal healthcare fraud and abuse statutes only apply to the Medicare fee-for-service program. However, physicians need to be aware that many federal healthcare statutes apply…
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A Physician May Violate Anti-Kickback Laws Even Without Steering Patients To A Specific Provider.
By Todd Rodriguez on
The United States Court of Appeals for the Seventh Circuit recently issued an interesting decision concerning the definition of “referral” in the context of federal anti-kickback…
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Excluded Physician Not Precluded from Collecting Pre-Exclusion Receivables According to OIG Advisory Opinion
By Todd Rodriguez on
A physician who was excluded from the Medicare program is not precluded from receiving payment for services rendered prior to the exclusion according to Advisory Opinion 15-02 published by the…
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Office of Inspector General Releases Work Plan for FY 2015
By Todd Rodriguez on
Each year, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) publishes a Work Plan for the coming fiscal year which summarizes new and ongoing…
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OIG Publishes Fraud Alert on Physician Lab Arrangements
By Todd Rodriguez on
Physician ancillary service joint ventures continue to proliferate and not surprisingly, federal and state regulators are on the lookout for arrangements which may violate fraud and abuse laws . In…
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