http://www.articlealley.com en-us editorial@articlealley.com Andrew B. Wachler & Amy K. Fehn, Wachler & Associates, P.C. The Federal False Claims Act (FCA) has long been a key weapon in the government’s arsenal to fight health care fraud and abuse. With the passage of the Fraud Enforcement and Recovery Act o... http://www.articlealley.com/article_1184902_18.html 19th October 2009 Medicare providers and suppliers targeted for prepayment complex medical review understand the financial burden that review of records prior to payment places on a medical practice. Prior to the Medicare Prescription Drug, Improvement and Modernization... http://www.articlealley.com/article_972331_18.html 09th July 2009 On December 28, 2007, the Centers for Medicare and Medicaid Services (CMS) displayed a final rule announcing that it was delaying the effective date of the majority of the newly revised anti-markup rule until January 1, 2009. CMS’ announcement came just... http://www.articlealley.com/article_972317_18.html 09th July 2009 On August 19, 2008, the Centers for Medicare and Medicaid Services (“CMS”) published final Stark rules in its 2009 Final Hospital Inpatient Prospective Payment Systems Rule (“Final Rule”). The Final Rule contains several significant modificat... http://www.articlealley.com/article_972313_18.html 09th July 2009 As of April 14, 2003, covered entities are expected to be in compliance with the HIPAA Privacy Rule and the April 21, 2005 deadline for Security is rapidly approaching. Health care providers and their attorneys are now left wondering where the liability ... http://www.articlealley.com/article_972261_18.html 09th July 2009 Recently, the Centers for Medicare and Medicaid (“CMS”) entered into the pay for performance arena with the Physician Quality Reporting Initiative (“PQRI” or “Initiative”) aimed at improving the quality of health care. Participants in the Ini... http://www.articlealley.com/article_972215_18.html 09th July 2009 In order to manage the growth of independent ambulatory surgery facilities (“ASF”) throughout Michigan, Blue Cross Blue Shield of Michigan (“BCBSM”) created Evidence of Need (“EON”) standards for ASFs participating with BCBSM. However, BCBSM ... http://www.articlealley.com/article_972187_18.html 09th July 2009 Introduction When structuring many common business relationships involving health care providers, attorneys must be aware of the myriad of Federal and State laws that may be implicated as a result of the arrangement. The health care industry is heavi... http://www.articlealley.com/article_972157_18.html 09th July 2009 Overview A health care provider’s claims for medical services may be audited by payors (e.g., Medicare, Blue Cross Blue Shield of Michigan (“BCBSM”) and Medicaid) for a number of reasons. Some audits are a result of random selection or some res... http://www.articlealley.com/article_972112_18.html 08th July 2009 The financial pressure on hospitals, physicians and other healthcare providers, as a result of increased scrutiny of claims and audit activity by third party payors, will not end soon. To the contrary, as part of the Tax Relief and Health Care Act of 20... http://www.articlealley.com/article_972084_18.html 08th July 2009 “No-show” patients are a part of any medical practice. Over the years, physicians and other practitioners have developed numerous policies in an attempt to prevent no-shows. Most practices institute such policies as a deterrent rather than for the p... http://www.articlealley.com/article_972073_18.html 08th July 2009 The long-awaited third and final phase of the rulemaking that amends the Stark regulations (Stark) was released by the Centers for Medicare and Medicaid Services (CMS) on August 27, 2007. The phase III final rule (Phase III) will be effective December 4... http://www.articlealley.com/article_972062_18.html 08th July 2009 Introduction The Centers for Medicare and Medicaid Services (CMS) issued its final rule regarding changes to the Medicare appeal procedures on March 5, 2005. This final rule was effective May 1, 2005. Legal counsel for providers and suppliers underg... http://www.articlealley.com/article_972028_18.html 08th July 2009 On November 22, 2006, the Detroit Medical Center (“DMC”) and Wayne State University (“WSU”) announced a temporizing resolution to a long-standing contractual dispute. This dispute threatened both the future of the DMC/WSU jointly sponsored reside... http://www.articlealley.com/article_969640_18.html 07th July 2009 I. INTRODUCTION The Centers for Medicare and Medicaid Services (“CMS” or “Medicare”) Recovery Audit Contractor (“RAC”) program has been made permanent and is expanding nationwide, beginning this year. Medicare providers, suppliers and the... http://www.articlealley.com/article_969616_18.html 07th July 2009 In recent years, the Centers for Medicare and Medicaid Services (“CMS”) has heavily scrutinized the terms and conditions under which Medicare will pay for diagnostic testing services, resulting in heightened regulatory action targeting certain diagnos... http://www.articlealley.com/article_969594_18.html 06th July 2009 The 2008 Medicare Physician Fee Schedule (MPFS) was published in the Federal Register on November 27, 2007. For the most part, the 2008 MPFS final rule will take effect January 1, 2008. This article will focus on two areas of the MPFS final rule that wi... http://www.articlealley.com/article_969579_18.html 06th July 2009 Over the past few years, there has been more intense focus on medical staff actions related to disruptive conduct of physicians. In the past, many hospitals did not have any policies, procedures or guidelines to assist them when faced with the unprofes... http://www.articlealley.com/article_969552_18.html 06th July 2009 Physician recruitment is a highly regulated activity and thus physicians involved in recruitment arrangements should understand the legal issues involved. This article generally addresses two primary laws involved in the relationship but does not cover a... http://www.articlealley.com/article_967797_18.html 06th July 2009 Introduction On March 16, 2000, the United States Department of Health and Human Services Office of Inspector General (the “OIG”) published its first “Compliance Program Guidance” for Nursing Facilities” (the “Guidance” or “2000 Guidanc... http://www.articlealley.com/article_967788_18.html 06th July 2009 Physicians, providers and suppliers providing services under Part A of Medicare, who have been subject to Medicare audits or claim denials resulting in overpayment demands, are aware that, currently if a Medicare fiscal intermediary identifies an alleged ... http://www.articlealley.com/article_967786_18.html 06th July 2009 When undertaking compliance measures, it is not uncommon to hear a physician attempt to justify the presence of billing errors by saying that the far majority of the billing is accurate and that one cannot worry too much about an occasional error here or ... http://www.articlealley.com/article_967781_18.html 06th July 2009 Earlier this year, Blue Cross Blue Shield of Michigan (“BCBSM”) published its amendment to the BCBSM Evidence-of-Need (“EON”) requirements for ambulatory surgery facilities (“ASFs”). These changes, in pertinent part: 1. Correlated the EON... http://www.articlealley.com/article_967777_18.html 06th July 2009 I. INTRODUCTION Attention radiology providers and suppliers: Get ready for increased Medicare auditing activity. The Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nat... http://www.articlealley.com/article_967745_18.html 06th July 2009 The financial pressure on hospitals, physicians and other healthcare providers, as a result of increased scrutiny of claims and audit activity by third party payors, will not end soon. To the contrary, as part of the Tax Relief and Health Care Act of 20... http://www.articlealley.com/article_967739_18.html 06th July 2009 The Federal Stark law prohibits physicians from referring Medicare/Medicaid beneficiaries to an entity in which they (or an immediate family member) have a financial relationship for designated health services (“DHS”), unless an exception applies. DH... http://www.articlealley.com/article_916625_17.html 05th June 2009 Laser treatment has been utilized with limited frequency for certain dermatological applications such as the removal of tattoos, acne scars, port wine stains, and skin blemishes for over a decade. However, in recent years, laser treatment for hair remova... http://www.articlealley.com/article_916605_17.html 05th June 2009 On August 19, 2008, the Centers for Medicare and Medicaid Services (“CMS”) published final Stark rules in its 2009 Final Hospital Inpatient Prospective Payment Systems rule (“Final Rule”). The Final Rule contains several important revisions to th... http://www.articlealley.com/article_916596_17.html 05th June 2009 Recently, the Centers for Medicare and Medicaid (“CMS”) entered into the pay for performance arena with the Physician Quality Reporting Initiative (“PQRI” or “Initiative”) aimed at improving the quality of health care. Participants in the Ini... http://www.articlealley.com/article_916584_17.html 05th June 2009 On December 28, 2007, the Centers for Medicare and Medicaid Services (CMS) displayed a final rule announcing that it was delaying the effective date of the majority of the newly revised anti-markup rule until January 1, 2009. CMS’ announcement came just... http://www.articlealley.com/article_916566_17.html 05th June 2009 Physician recruitment is a highly regulated activity and thus physicians involved in recruitment arrangements should understand the legal issues involved. This article generally addresses two primary laws involved in the relationship but does not cover a... http://www.articlealley.com/article_916272_18.html 05th June 2009 In recent years, diagnostic imaging services have been intensively scrutinized by the federal government. This article will summarize some of the more significant recent federal regulatory changes included in the 2009 Medicare Final Physician Fee Schedul... http://www.articlealley.com/article_916050_18.html 05th June 2009