Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released final regulations implementing the federal Physician Payment Sunshine Act contained in the Federal Accountable Care Act.  Among other things, the Sunshine Act requires manufacturers of drugs, biologics, devices and medical supplies to track and report payments (including anything of value) made to physicians.  As many physicians Continue Reading

Yesterday the U.S. Department of Justice announced that it has entered into a $26M False Claims settlement with a dermatologist in Florida.  According to the DOJ, this is one of the largest False Claims settlements against an individual in history.  The physician was accused of allegedly accepting kickbacks from a pathology lab and billing for medically unnecessary services. … Continue Reading

Today I am focusing on the self-referral ban under the federal Stark laws. In particular, a recent case – Fresenius Medical Care Holdings, Inc. v. Tucker (Dkt. No. 4:03-cv-00411-SPM-GRJ (Jan. 10, 2013, 11th Cir.)) – discussed the interplay between those laws and a State’s attempt to impose more stringent requirements. 

The court first focused on two exceptions to the Stark … Continue Reading

Last week the U.S. Department of Health and Human Services (HHS) released final regulations modifying existing HIPAA enforcement, privacy and security regulations. Although a number of the changes merely serve as clarification of existing regulations, the modifications impose a number of new requirements on covered entities and business associates.

Some of the important issues addressed in the new rules include … Continue Reading

Now that the new year is upon us, today’s post will look at the Department of Health and Human Services’ Office of Inspector General (OIG), in particular, OIG’s priorities for 2013.   According to OIG’s Fiscal Year 2013 Work Plan, it will be focusing upon a number of topics of interest – including some items not addressed last … Continue Reading

It appears to be business as usual on Capitol Hill this New Year’s Eve.  Once again, Congress has failed to fix the sustainable growth rate formula in the Medicare physician fee schedule. Unless at least a temporary "patch" is put in place to keep Medicare physician payment rates steady, physicians will experience a 27% cut starting January 1, 2013. 

Year … Continue Reading

According to a recent study published in the Journal of the Association of American Medical Colleges, a primary care physician who graduates with education debt of $160,000 should be able to raise a family, live in an expensive urban area, and repay their debt in 10 years without incurring additional debt, as long as their household income and spending … Continue Reading

It’s no secret that Medicare pays significantly more for certain services when they are performed in a hospital outpatient department than when they are performed in a physician office.  In fact, this is one of the reasons privately practicing physicians have been folding up shop in favor of hospital employment.  Hospitals can make more from these services than physicians and, therefore, can generally … Continue Reading

The 7th Circuit Court of Appeals recently issued a decision of interest to physicians and teaching hospitals. It concerns the method of rotating teaching physicians between multiple surgeries and billing Medicare for those services.  

The case involves so-called "qui tam" claims (essentially, a whistleblower case) against a teaching hospital, by which a successful claimant gets to keep a portion Continue Reading