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Please Click HerePosted on April 6, 2017 by Ruder Ware Alumni
The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical supplies and certain group purchasing organizations to report annually to the Centers for Medicare & Medicaid Services (CMS) certain payments or items of […]
Posted on April 6, 2017 by Emilu E.C. Larson
A new safe harbor was recently issued by the Health and Human Services (HHS) Office of Inspector General (OIG) that permits eligible health care providers to offer free or discounted transportation to established patients. The safe harbor addresses concerns that offering free goods and/or services to patients might be considered payment of illegal “remuneration” in […]
Posted on April 5, 2017 by Ruder Ware Alumni
By now the whole world knows about Sally Yates. We are likely to see a lot more of her as a central figure in Congressional investigations. For some of us who deal with compliance investigations, Sally Yates was famous long before her refusal to defend the immigration ban. She was the author of the famous […]
Posted on April 5, 2017 by Ruder Ware Alumni
When the Center for Medicare and Medicaid Services (CMS) finally issued final regulations under the 60-day repayment rule, it implemented a new standard requiring a provider to affirmatively exercise reasonable diligence to identify potential overpayments. This was a change from the proposed regulations that held providers to a much lower affirmative duty to exercise diligence […]
Posted on April 5, 2017 by Ruder Ware Alumni
Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices. These risk areas include: Improper use of multiple removal CPT codes; Billing for “impossibly long days”; Failure to follow supervisions rules required to permit “incident to” billing; Creating incentives for overutilization; and Performing “outlier” levels of […]
Posted on April 4, 2017 by Ruder Ware Alumni
Given the increased importance of compliance, it is helpful for providers to get a feel for what constitutes “best practice” when operating a compliance program. “Best Practices” is a term thrown around all of the time in the business world. It is used in many contexts and takes on a variety of meanings depending on […]
Posted on April 4, 2017 by Ruder Ware Alumni
In February, we reported on revisions to the Conditions of Participation for Home Health Agencies (HHA) released by the Centers for Medicare & Medicaid Services (CMS). CMS has now proposed the effective date of new Conditions of Participation (CoP) be delayed by six months. The original effective date of the new regulations was July 13, […]
Posted on March 30, 2017 by Ruder Ware Alumni
The HHS Office of Inspector General offers providers an opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations. Even though the OIG’s Provider Self-Disclosure Protocols (“SDP”) can be very compelling, the decision whether to utilize the OIG’s self-disclosure protocols is often very […]
Posted on March 30, 2017 by Ruder Ware Alumni
You have adopted your basic compliance policies and procedures, established a reporting system and visibly rolled out your new compliance program. Your board of directors has passed a resolution decisively stating its commitment to compliance. The CEO issued a letter stating her commitment to compliance and mandating every person in the organization follow the Code […]
Posted on March 30, 2017 by Ruder Ware Alumni
I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians. This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group. In this context it is limited to simple posturing to attempt to get a better financial deal in the negotiated […]