Last week President Obama signed legislation that will delay Medicare payment cuts for one more year. The reduction in pay, 25 percent, had been scheduled to begin on January 1, 2011. The American Medical Association strongly advocated for the delay that is longer than the previous five delays over the…
The U.S. District Court for the Eastern District of Virginia ruled that Section 1501 of the Patient Protection and Affordable Care Act (PPACA) is unconstitutional. Shortly after PPACA was passed in March 2010, Virginia passed a state statute that conflicted with the individual mandate found in Section 1501 of PPACA…
Last week, the House and Senate passed the “Red Flag Program Clarification Act of 2010.” The Act limits the definition of “creditor” to a person who obtains or uses consumer reports in connection with a credit transaction, furnishes information to consumer reporting agencies in connection with credit transactions, or advances…
The United States Justice Department reported that in 2009 it collected $3 billion from pursuing health care fraud and other false claims against the federal government. More than 80% of the recoveries were from healthcare fraud, including qui tam actions under the False Claims Act. Bloomberg News reported that Tony…
The proposed purchase of the Detroit Medical Center by Vanguard Health Systems Inc. has been conditionally approved by the Attorney General of Michigan Mike Cox. This sale would bring a purported $1.5 billion in funding for the center. The deal is tentatively set to take place on December 31, 2010…
As the focus on health care fraud continues within the federal government, Department of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder recently participated in the third regional health care fraud prevention summit in Brooklyn, New York. The stated purpose of the summit was to bring together…
The United States Supreme Court refused to hear a legal challenge to the healthcare reform law, the Patient Protection and Affordable Care Act (PPACA). The Court declined without comment to hear the case originally filed in federal court in California by Steve Baldwin and the Pacific Justice Institute. The plaintiffs…
The device manufacturer, ELA Medical, Inc. agreed to pay the United States $9,178,000 to settle allegations that it violated the False Claims Act by giving kickbacks to cardiologists in exchange for the cardiologists ordering and causing hospitals to order ELA’s cardiac devices. The settlement resolves a qui tam action from…
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule on November 5 regarding RAC activities for Medicaid programs. Section 6411 of the Patient Protection and Affordable Care Act (PPACA) requires states to contract with one or more Medicaid RACs by December 31, 2010. By that date, states…
Cardiac Pacemaker Implantations and Cardiac Defibrillator Implantations were two of the most targeted services from an overpayment standpoint during the RAC demonstration period. This makes them potential prime targets for the permanent RACs in the future. As such, sufficient documentation of the need for services provided at the inpatient level of…