Legal & Regulatory Issues

CMS is going ahead with plans to slash Medicare physician reimbursements by 21.2 percent next year, following a requirement to put reimbursements in line with a sustainable growth rate formula, according to a final rule issued by CMS.

Due to a request from Congress, the Federal Trade Commission is delaying enforcement of the Red Flags Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC, according to an FTC news release.

The Georgia Department of Insurance has fined United Healthcare Insurance Co. $750,000 for failure to pay claims within 15 days of receipt as is required by Georgia law, according to a report by the Atlanta Journal-Constitution.

Noel Wayne Jhagroo, the owner and operator of a Houston-area durable medical equipment company has pleaded guilty to defrauding the Medicare program in a scheme to submit approximately $962,000 in fraudulent claims, according to a Department of Justice News release.

South Texas Health Systems in McAllen, Texas, has agreed to pay $27.5 million to settle claims that it paid kickbacks to physicians for referring patients to its hospitals, according to a release from the U.S. Department of Justice.

Jean Joseph Paul, the operator of God Cares, a home health company located in Miami-Dade County, was arrested on charges he defrauded the Florida Medicaid program for more than $54,000, according to news release by the Office of the Attorney…

Thirteen states are suing Thousand Oaks, Calif.-based drug manufacturer Amgen alleging that the company provided kickbacks to medical providers to boost sales of Aranesp, a medication for anemia, according to a report by the Los Angeles Times.

Daisy Martinez of Miami pleaded guilty to participating in a conspiracy to defraud the Medicare program of more than $15 million, according to a Department of Justice news release.

The House's version of the "Affordable Healthcare for America Act,"  HR 3962, which was released on Oct. 29, includes language against physician-ownership of hospitals, similar to the language included in draft versions of HR 3200, according to a statement by…

House Democrats, following their Senate counterparts, have put a proposed Medicare pay fix for physicians into a separate bill from their health reform legislation, according to the Wall Street Journal Health Blog.