The U.S. Department (DOJ) and the Health Alliance of Greater Cincinnati entered into an agreement to settle a False Claims Act lawsuit with the DOJ alleging that from 1997 to 2004 Christ Hospital, a former member of the Health Alliance, scheduled cardiologists at a diagnostic unit based on the amount…
Wachler & Associates Health Law Blog
CMS Releases MLN Matters Article Explaining Additions to the Medicare Program Integrity Manual
On May 14, 2010, the Centers for Medicare and Medicaid Services (CMS) released an MLN Matters article explaining Change Request (CR) 6954. CR 6954 adds Section 3.14 to the Medicare Program Integrity Manual. This section clarifies language regarding clinical review judgments. It requires Medicare claim review contractors to instruct their…
MLN Matters Article Discusses New Remittance Advice Code Created to Identify Claims Subject to the Limitation on Home Health Prospective Payment System Outlier Payments
Last month the Centers for Medicare and Medicaid Services (CMS) published an MLN Matters Article regarding changes to remittance advice coding. The article is directed towards Home Health Agencies that submit claims to a Regional Home Health Intermediary (RHHI) or to the Home Health Medicare Administrative Contractor (HH MAC –…
CMS Clarifies Signature Requirements
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6698 to clarify how Medicare claim review contractors review claims and medical documentation submitted by providers. This clarification included an outline of new rules for signatures and added language for e-prescribing. The previous language in the Program Integrity…
U.S. Western District Court of Michigan Dismisses False Claims Act Claim for Failure to State a Claim with the Required Particularity
Earlier this month, the U.S. District Court for the Western District of Michigan granted a defendant’s motion to dismiss a qui tam action against it. The court held that the relator failed to state a claim with the required particularity. Robert Lauricia filed the qui tam action under the False…
PPACA Grants Authority to the Secretary of the Department of Health & Human Services to Require Health Care Providers to Adopt Compliance Programs
Section 6401 of the Patient Protection and Affordable Care Act (PPACA) grants the Secretary of the Department of Health and Human Services (the “Secretary”) the authority to require health care providers to adopt compliance programs as a condition of participation in the Medicare, Medicaid and CHIP programs. Before the PPACA,…
CMS Issues New Transmittal to Address Concerns with Recoupments
The Centers for Medicare and Medicaid Services (CMS) issued a new transmittal to address concerns regarding the reporting of recoupment for overpayment on the remittance advice (RA). During the RAC demonstration project providers would receive an RA, which is a notice of payments and adjustments sent by Medicare contractors to…
Request for Information on the Expansion of the Right to Receive an Accounting of Disclosures
The U.S. Department of Health & Human Services Office for Civil Rights (OCR) published a request for information (RFI) on the Health Information Technology for Economic and Clinical Health (HITECH) Act’s expansion of an individual’s right to receive an accounting of disclosures under the Health Insurance Portability and Accountability Act…
Surgeon Sentenced to Prison for HIPAA Violation
The first defendant to receive a prison sentence for a HIPAA privacy violation was sentenced to four months in prison after admitting to illegally accessing protected health information contained in electronic medical records of celebrities and others. The defendant, a former UCLA Health System surgeon, pleaded guilty in January to…
Requirements for the Home Health Care CAHPS Survey
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey is designed to measure the experiences of individuals receiving home health care from Medicare-certified home health care providers. The CAHPS has three broad goals: (1) to produce comparable data on the patient’s perspective that allows objective and…