The United States Fifth Court of Appeals has upheld a district court ruling that a health plan violated the Employee Retirement Income Security Act by refusing payment to a hospital for health services it felt were not "reasonable and customary,"…
Legal & Regulatory Issues
In a comment letter to CMS on its proposed outpatient prospective payment system rule to start Jan. 1, 2011, the AHA expressed "serious concerns" about "the continuing failure of CMS to require ASC quality and cost reporting."
An Ohio appeals court has upheld a lower court's judgment to clear an ASC, orthopedic surgeon and CRNA sued by a patient who claimed her lung was punctured during a regional block placement, according to an Ohio Court of Appeals…
Robert J. Tomlinson, MD, a Fayetteville, Ark.-based orthopedic surgeon has been sentenced to 10 months in prison for healthcare fraud, according to an Arkansas News report.
California regulators approved a rate increase for Anthem Blue Cross that was hefty but still much lower than the proposal that set off a firestorm of criticisms during the healthcare reform debate in February, according to a report by the…
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Anesthesiologist Barry K. Ray Jr., MD, of Tinton Falls, N.J., has been charged with conspiring to sell prescription drugs, according to a news release from the Monmouth County Prosecutor's Office.
Here are 10 of the largest, recent fraud and abuse, Stark Act and anti-kickback violation settlements in 2010, listed in order of highest settlement amount. Click on the name of the organization or individual to learn more about their case…
The Recovery Audit Contractor for Region D has begun medical necessity reviews for 10 types of inpatient hospital conditions, according to a report by AHA News Now.
Commenting on proposed changes in the Medicare Physician Fee Schedule and other Part B payment policies for 2011, the AHA called for a permanent fix of the automatic physician fee cut, disclosure of methodology in the rule's marketbasket update and…
A recent report by the HHS' Office of Inspector General found that in 2007, Medicare overpaid physicians by an estimated $13.8 million due to incorrect site-of-service codes attached to claims.