Tag Archives: Hospitals

D.C. District Court Vacates CMS Final Rule, Finds that CMS’ Lesser Reimbursement of Services Provided at Grandfathered Off-Campus Provider-Based Departments Was Improper

On September 17, 2019, the U.S. District Court for the District of Columbia ruled against the Centers for Medicare and Medicaid Services (“CMS”), vacating CMS’ 2018 Final OPPS Rule, which cut Medicare reimbursement rates for certain outpatient hospital services provided at certain off-campus provider-based departments (“PBDs”).… Continue Reading

Eleventh Circuit Affirms Key Kickback Statute, Stark Law, and False Claims Act Principles in Dismissing Allegations Against HCA

On July 31, 2019, the U.S. Court of Appeals for the Eleventh Circuit affirmed a lower court’s decision to grant summary judgment to hospital operator HCA and dismiss relator Thomas Bingham’s allegations. Bingham v. HCA (S.D. Fla. July 31, 2019) (“Op.”). In a well-reasoned opinion, the Court affirmed several key holdings: There is no “remuneration”, … Continue Reading

Proposed and Expanded Disclosure Obligations for Hospitals Regarding not Only Gross Charges, but Third Party Payor Pricing as Well

On July 29, 2019, CMS released its proposed outpatient prospective payment system (“OPPS”) rule outlining a variety of changes it may implement for calendar year 2020. One proposal that has inspired immediate reactions from industry members would require hospitals to disclose certain additional pricing information, including some prices negotiated with third party payors, to the … Continue Reading

Notes on Day 2 of the JP Morgan Healthcare Conference

San Francisco (Tuesday, January 9, 2018): Day 2 of the 2018 JP Morgan Healthcare Conference provided concrete examples of the trends that have been discussed in recent years – the impact of shifting healthcare delivery modalities on hospitals, the opportunity for retail medicine, the need for more effective management of chronic conditions and the increasing … Continue Reading

Quality, Reimbursement and the Medical Staff

By Karie Rego The most difficult issue a hospital can face involves allegations of poor quality coupled with billing fraud. These allegations can be devastating to a hospital’s operations and its reputation. It is essential that hospital administration, the medical staff, legal and compliance officers work together quickly and efficiently to verify and address allegations.  Hospitals should have … Continue Reading

How to Avoid an Interventional Cardiology Billing and Quality Scandals

By Karie Rego Ever since the Redding Medical Center government investigation found inappropriate percutanteous coronary interventions (PCI), the medically necessity of PCI has been a highly debated topic. This past year, there have been two other similar cases involving providers in Maryland and Pennsylvania. In Maryland, the state even considered adopting it’s own quality guidelines. This is … Continue Reading

ACO Regulations: Still Waiting

By Eric A. Klein Healthcare providers must continue to wait for the Centers for Medicare and Medicaid Services (CMS) to release regulations governing accountable care organizations (ACOs), despite predictions the regulations would be issued last week. The regulations were not forthcoming, possibly due to the tense atmosphere in Washington over the federal budget. ACOs, created by a … Continue Reading

OIG Releases Fiscal Year 2011 Work Plan

By Ken Yood and Lynsey Mitchel The mission of the Office of the Inspector General ("OIG") is to protect the integrity of the programs and operations of the Department of Health & Human Services, for example Medicare, by detecting and preventing waste, fraud and abuse, and identifying opportunities to improve program economy, efficiency and effectiveness. The Work … Continue Reading
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