Posted on Health Care Law News May 20, 2013 by author
On May 17, 2013, HHS published a rule change that will allow state Medicaid programs to use federal funds to data mine for erroneous and false claims. The rule change is expected to generate an estimated $60 million in additional recoveries over the next decade. In order to obtain a portion of the approximately $12 Read more →
Posted on Health Care Law News May 19, 2013 by author
In order to avoid erroneous billing practices for “New Patient” Evaluation and Management services, CMS issued Change Request 8165 which informs Medicare contractors about changes to Medicare’s Common Working File system that detects errors in billing. According to Medicare manuals, “New Patient” is defined as: a patient who has not received any professional services, i.e., Read more →
Posted on Health Care Law News May 19, 2013 by author
On February 8, 2013, CMS issued a final rule intended to increase public awareness of financial relationships between manufacturers of drugs, devices, biological and medical supplies. The rule also seeks to reveal relationships between Group Purchasing Organizations (GPOs), and physician and teaching hospitals. The final rule, titled: “Medicare, Medicaid, Children’s Health Insurance Programs; Transparency Reports Read more →
Posted on Health Care Law News May 11, 2013 by author
In Glynn v. Edo Corp., 710 F.3d 209 (4th Cir. 2013), the Fourth Circuit recently clarified what constitutes “protected activity” under the anti-retaliation provision of the False Claims Act, 31 U.S.C. § 3730 (h)(1). As background, to prove a FCA retaliation claim, a whistleblower must show, inter alia, that he was engaged in “protected activity” Read more →
Posted on Health Care Law News May 11, 2013 by author
On May 8, 2013, the Department of Health and Human Services Office of Inspector General (HHS-OIG) released a Special Advisory Opinion regarding Medicare Providers’ obligations to ensure that they do not employ or contract with excluded providers or entities in connection with the provision of Medicare services. The provision against employing or contracting with excluded Read more →