The Office of the Inspector General recently issued Advisory Opinion 08-08. This Advisory Opinion deals with a physician/hospital joint-venture surgery center. Here, the Advisory Opinion was requested because certain physicians who invested in the joint-venture were themselves not "safe harbor"…
Legal & Regulatory Issues
Arecent article in Modern Healthcare reported in its headline that there are "Savings still seen in House measure on doc-ownership of hospitals: CBO (Congressional Budget Office)." I find it almost laughable that there are folks in Washington who think all…
This continues to be a fascinating time in the surgery center area. There continues to be growth, although it is slightly slower. There is also an increasing variety of legal issues and concerns that are facing ASCs. There have also…
The results of peer review proceedings at the another hospital may not be enough to base a dismissal decision upon, according to an opinion issued by the Court of Appeals of California, Fifth District.
CMS created a Stark Act exception in 2006 to let hospitals and other entities provide physicians with software and other assistance relating to implementation of electronic health records systems. Over the past few years, the utilization of this exception has…
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The Office of the Inspector General recently issued Advisory Opinion 08-08. This Advisory Opinion deals with a physician/hospital joint-venture surgery center. Here, the Advisory Opinion was requested because certain physicians who invested in the joint-venture were themselves not "safe harbor"…
Lester E. Cox Medical Centers, a health care system headquartered in Springfield, Mo., will pay $60 million to settle claims that it violated the False Claims Act, the anti-kickback statute and the Stark statute, according to the U.S. Department of…
According to CMS's recovery audit contractor (RAC) evaluation report, here are the top five hospital services with overpayments from 2005 through March 27.
This is a review of claim facts and corrective actions taken for excisional debridements (complex review, incorrect coding), one of the top five overpaid services in inpatient hospitals, as explained in CMS's recovery audit contractor evaluation report.
Citing "concerns about physicians responding to incentive payment and shared savings programs by stinting, cherry picking, steering and making quicker-sicker discharges," CMS has proposed a self-referral exception for such incentive and gain-sharing programs aimed at preventing these potential issues while…