CMS does not expect its Medicare recovery audit contractors to conduct complex reviews for medical necessity of hospital services until 2010, according to a news release from the American Hospital Association.
Legal & Regulatory Issues
President Obama's plan to reduce healthcare spending — which calls for the collaboration of doctors, insurers and healthcare facilities to develop a strategy that would slow the growth of healthcare costs — creates legal risks for the companies involved, according…
Senator John D. Rockefeller IV (D-W.Va.) introduced new legislation to Congress that would expand the role of the Medicare Payment Advisory Commission to determine and implement Medicare reimbursement policies, according to a news release from Sen. Rockefeller's office.
Three hospitals in the St. Paul, Minn.-based HealthEast Care System agreed to pay the United States $2.28 million to settle allegations that they submitted false claims to Medicare, according to a U.S. Department of Justice news release.
CMS has issued answers to four new frequently asked questions regarding Recovery Audit Contractors. They are as follows:
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Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius have announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team, to combat Medicare fraud, according to a U.S. Department of…
Deborah Heart & Lung Center in Brown Mills, N.J., is suing Virtua Health, accusing Virtua Memorial Hospital in Mt. Holly, N.J., and four cardiologists from The Cardiology Group of slander and unfair competition, according to a report by the Philadelphia…
CMS, in the FY 2008 and FY 2009 IPPS regulations, finalized changes relating to hospitals serving Medicare/Medicaid beneficiaries that require such hospitals and their physician owners to disclose physician ownership information to patients. The disclosure requirements become effective June 8,…
A study has found that the total cost of medical practice interaction with insurers is $21-$31 billion a year, or more than $68,000 per physician on average, according to an MGMA news release.
This is a short summary of 15 anti-kickback and fraud cases and investigations that have made headlines in 2009. The situations involve a range of participants including hospitals, device companies, physicians, payors and other suppliers.