CMS has announced that it will delay enforcement or evaluation of the physician supervision requirements for therapeutic services provided to outpatients of Critical Access Hospitals for the duration of the 2010 calendar year. These requirements, initially set forth in its 2010 OPPS Final Rule, involve “direct supervision” over therapeutic services furnished in hospital outpatient departments and are difficult for many CAHs to meet. CMS plans to revisit the issue of supervision of therapeutic services provided to hospital outpatients in CAHs through the annual rulemaking cycle for CY 2011.
von Briesen Health Law Blog
March 23, 2010
March 16, 2010
The OIG Has Published Its Compendium of Unimplemented Recommendations for 2010
The OIG’s Compendium lists the ”significant,” but not yet implemented, recommendations that the OIG has provided to the Department of Health & Human Services (”DHHS”). The OIG believes these recommendations have the potential for cost savings and greater program efficiency. A number of the recommendations are aimed at the Medicare and Medicaid programs. Among its “priority” recommendations, the OIG includes:
- Modifying policies to eliminate Medicare payments for hospital bad debts.
- Ensuring the processing of Medicare denial of payment remedies for noncompliant nursing homes.
- Ensuring that hospice claims for beneficiaries in nursing facilities comply with Medicare coverage requirements.
- Adjusting the eye global surger fees to reflect the number of E&M services actually being provided.
- Ensuring that medical equipment suppliers comply with Medicare enrollment standards.
- Modifying payments to Medicare Advantage organizations.
- Placing a ceiling on adminsitrative costs included in the bid proposals of Medicare Advantage organizations.
You may view the entire 194-page Compendium for 2010 here.
January 29, 2010
CMS Approves Organizations to Accredit Advanced Imaging Services Supplies
View CMS’s full press release. The American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission have each been designated to accredit suppliers furnishing the technical component of advanced diagnostic imaging procedures. All suppliers who furnish the technical component of advancing imaging must become accredited by January 1, 2012, as required by the Medicare Improvements for Patients and Providers Act of 2008.
January 28, 2010
National Summit on Health Care Fraud – Webcast
The National Summit on Health Care Fraud webcast.
Thursday, January 28, 2010 from 8:45 a.m. – 4:00 p.m. (CST)
January 26, 2010
City of Angels Executives No Angels
The U.S. Attorney recently settled its case against the former owners of a Los Angeles Medical Center. The former executives have agreed to pay over $10 million for paying kickbacks to recruiters to bring homeless people to the hospital facility for unnecessary medical services. View the U.S. Attorney’s statement related to this case.
January 14, 2010
The OIG Issues an Updated Special Fraud Alert on DME Telemarketing
The OIG has issued an updated Special Fraud Alert on telemarketing by DME suppliers. The updated Alert was apparently issued in light of information that some DME suppliers continue to use marketing firms to place unsolicited telephone calls to Medicare beneficiaries. The original alert was published in March 2003.
The Alert reminds DME suppliers that federal law generally prohibits DME suppliers from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of DME, except in some limited circumstances. The rule applies even if another firm contacts the beneficiary on the DME supplier’s behalf. The Alert also reminds DME suppliers that claims for items or services generated from a prohibited solicitation could expose the DME supplier and the telemarketer to criminal, civil and administrative penalties. You can review the OIG’s Alert here.
January 11, 2010
Minnesota CAH Settles False Claims Act Allegations for Almost One Million Dollars
The Justice Department recently announced a $846,461 settlement by a Minnesota critical access hospital and one of its physician’s to settle False Claims Act allegations. A former doctor at the critical access hospital filed a qui tam (“whistleblower”) action alleging that the physician admitted patients that did not need to be admitted, or kept other patients in acute care when doing so was not medically necessary, and ordered unnecessary testing. The whistleblower contended that he complained to the hospital about the physician’s alleged practices, but that the hospital did nothing. The government investigated the allegations, reviewing nearly 200 of the physician’s patient admissions. Several admissions were identified as not medically necessary under Medicare rules. Additionally, the investigation revealed that the physician generated more than $4 million a year in billings for the hospital, which is 10 times that of its other doctors. You may read the DOJ’s press release here.
December 7, 2009
CMS Modifies RAC Document Request Limit
In response to comments from RACs, providers/suppliers and various health care associations, CMS has modified its limit for document requests from the RAC program for FY 2010. To view this modification, see http://www.cms.hhs.gov/RAC/Downloads/DRGvalidationADRlimitforFY2010.pdf.
December 3, 2009
CMS Grants Continued Deeming Authority for The Joint Commission
The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) has approved the continuation of deeming authority for The Joint Commission’s hospital accreditation program through July 15, 2014.
The CMS designation means that hospitals accredited by The Joint Commission may choose to be “deemed” as meeting Medicare and Medicaid certification requirements. For years, The Joint Commission had automatic deemed status to survey hospitals on behalf of CMS, but in 2008 CMS required The Joint Commission to reapply for this status. As a result, the commission needed to update some of its requirements to more closely align with the Medicare Conditions of Participation. (For example, see our recent article “Medical Staff Update: October 2009” for examples of changes affecting the medical staff.)
Accreditation by The Joint Commission is voluntary and seeking deemed status through accreditation is an option, not a requirement. Hospitals seeking Medicare approval may choose to be surveyed either by an accrediting body, such as The Joint Commission, or by state surveyors on behalf of CMS. All deemed status surveys are unannounced, a policy The Joint Commission instituted into its accreditation process in 2006.
November 18, 2009
HHS and CMS Revise and Improve Medicare Fee-for-Service Error Rate Calculations
CMS announced today that the Department of Health and Human Services (HHS) will employ new standards in calculating improper Medicare payment rates for 2009. The tougher standards are intended to facilitate CMS’s ability to target improper payments. The new standards are part of the Obama Administration’s goal of reducing waste, fraud, and abuse in Medicare. HHS Secretary Kathleen Sebelius explained that “[t]hrough a more stringent review of Medicare claims, we have been able to establish a more complete accounting of errors, enabling CMS to take more actionable steps to further reduce the error rate and identify abusive or potentially fraudulent actions before they become problems.”
CMS’s full press release may be found here.