In a recent Advisory Opinion (No. 16-02), the OIG concluded that it would not seek sanctions against a state-run hospital (the “Hospital”) under the federal anti-kickback statute or the civil
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Medicare
Nursing Home Fraud Scam Results in Conviction for “King of Nursing Homes”
By Edward J. Cyran on
Called by some the “King of Nursing Homes” for his many low-income nursing home patients in northeast Illinois, Dr. Venkateswara Kuchipudi was recently convicted for referring patients to Sacred Heart…
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CMS Finally Makes Reasonable Changes to 60-Day Overpayment Rule
By Edward J. Cyran on
The Affordable Care Act (ACA) requires Medicare providers to return overpayments within 60 days of the date they are identified in order to avoid liability under the False Claims Act. …
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The Switch to ICD-10
By Edward J. Cyran on
The long-anticipated implementation of ICD-10 coding finally began this past Thursday, October 1, 2015. As of that date, government and commercial payors ceased to accept claims under the old coding…
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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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Expanded Authority for CMS to Deny Enrollment and Revoke Medicare Billing Privileges
By Edward J. Cyran on
You may have heard that CMS recently expanded its authority to deny enrollment and revoke the Medicare billing privileges of providers and suppliers. The new changes could affect any physician,…
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CMS Issues FY2015 Medicare Physician Fee Schedule
By Todd Rodriguez on
Last week, the Centers for Medicare and Medicaid Services (CMS) issued the final Physician Fee Schedule for Fiscal Year 2015. The annual Physician Fee Schedule includes various policy and…
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It’s Official (at least for now): ICD-10 Implementation Date is Now October 1, 2015
By Todd Rodriguez on
According to a final rule published by the Centers for Medicare and Medicaid Services on August 4, 2014, providers will be required to use the International Classification of Diseases, 10th…
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Physician-Hospital Integration Strategies
By Todd Rodriguez on
As the implementation of the federal Affordable Care Act (ACA) continues in fits and starts, healthcare providers are scrambling to best position themselves to accommodate anticipated and developing payment models. …
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Budget Sequester Brings Bad News for Physicians
By Todd Rodriguez on
Unless you’ve been living under a rock for the last several weeks, you are likely well aware of the budget sequester that took effect on March 1. The sequestration requires…
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