As reported in the Kansas City and Wichita Business Journals, in January 2014, CMS will begin enforcing a law requiring the supervision of outpatient physical therapy services by physician or non-physician practitioners. Outpatient physical therapy services that do not meet this supervision requirement will not be reimbursed by Medicaid.
Critical Access Hospitals are a critical to providing access to health care in rural America, yet they face devastating budget cuts and must take action to survive.
The Congressional Budget Office estimates the costs of maintaining physician Medicare reimbursement at current levels and preventing cuts to the sustainable growth rate (SGR) formula at $139 billion over the next 10 years. Today, in an attempt to address that issue, the House Energy and Commerce Health Subcommittee approved legislation aimed at repealing the Medicare physician payment system that is presently in place.
As previously posted in this Blog, the retrial in the case against Tuomey Healthcare System Inc. (Tuomey) alleging it violated the Stark Law and the False Claims Act (FCA) by illegally paying referring physicians started last month. After a month long retrial, the jury found that Tuomey’s compensation arrangements with referring physicians violated the Stark Law. The result, nearly 22,000 false claims and more than $39 million in overpayments. In total, with fines and penalties Toumey is facing $357 million in potential liabilities. Tuomey officials have indicated that such a large penalty may cause the closure of its business.
Last week, The U.S. Department of Health & Human Services, Office of Inspector General (OIG) published an “Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” (2013 Special Advisory Bulletin). As an update to the Bulletin also addressing the effect of exclusion issued in 1999, the 2013 Special Advisory Bulletin addresses frequently asked questions regarding the scope of exclusions and the Affordable Care Act’s (ACA) expansion of the OIG’s exclusion authority.
The prevailing sentiment is that developing and maintaining a corporate compliance program in a health care organization is a costly burden. Many health care organizations have compliance policies only because they are required and may lessen the penalties associated with regulatory enforcement. In fact, the financial strain of maintaining regulatory compliance is a common issue raised by providers and those in health care administration. In countless discussions, articles, and presentations, the cost of maintaining compliance with the current mountain and the seemingly always forthcoming tsunami of regulations is often listed as a key driver of the current physician employment boom. However, these views are wrong, a corporate compliance program is an investment opportunity that when properly developed and executed provides opportunity for a significant return on investment.
Opening arguments begin today in the second trial in a lawsuit filed by a whistleblower-physician against Tuomey Healthcare System, Inc. (Tuomey). The United States intervened in the matter which alleges that Tuomey entered into part-time employment agreements with 19 physicians that violated the Stark law resulting in False Claims Act (FCA) liability for Tuomey because as the government alleges, that Tuomey took into takes into account the revenue it expected to receive from physicians’ referrals to value the physicians’ base compensation.
The Stark exception and the Anti-kickback safe harbor that protect electronic health record (EHR) donation to physicians are both set to expire on December 31, 2013. This week, in response to this looming deadline, the Centers for Medicare & Medicaid Services (CMS) introduced a rule that would extend the Stark exception to December 31, 2016. Also this week, the Department of Health and Human Services Office of Inspector General (OIG) introduced a proposed rule extending the Anti-kickback safe harbor to December 31, 2016.
CMS issued a new rule on March 13, 2013, allowing providers to be paid for services billed under Medicare Part A, which should have been billed under Part B. However, a notice of proposed rulemaking issued the same day states that those claims must still be submitted within a strict one-year window that renders the new rule ineffective.
McKesson Corp., Allscripts, athenahealth Inc., Greenway Medical Technologies Inc., RelayHealth, and Cerner announced at the 2013 Healthcare Information and Management Systems Society annual meeting in New Orleans that they have banded together to form an independent trade association.