Tag Archives: Medicare

Is it Legal to Maximize Value of Secondary Diagnosis Codes?

By selecting a more severe Secondary Diagnosis Code for a patient, a physician may increase the reimbursement due from Medicare. If a hospital intentionally changes codes across its patient population, the increased revenue can be substantial. Is that legal? A federal district court in Texas faced this question when a relator filed suit under the … Continue Reading

CMS Issues Medicare and Medicaid Final Rule: Significant Changes to Conditions of Participation

On Wednesday, the Centers for Medicare and Medicaid Services (“CMS”) issued a second round of long-awaited red tape reduction initiatives aimed at ameliorating overly burdensome provider regulations.  The changes, memorialized within a Final Rule scheduled for publication on May 12, 2014 (available for review here: http://federalregister.gov/a/2014-10687) (“Unpublished Final Rule”)  include significant easing of Conditions of … Continue Reading

Is Your Name on the List?

Given the 880,000 names of physicians released by Medicare Wednesday, physicians who treat Medicare patients can expect their names to be on the list.  The list, searchable here, contains the name of the provider, the specialty area, the city, county and state as well as the total payments made to the provider by Medicare for … Continue Reading

District Court Deals Major Blow to Halifax in Bank Busting Qui Tam Suit

On November 13, U.S. District Court Judge Gregory A. Presnell of the Middle District of Florida partially granted the U.S. government’s summary judgment motion against Halifax Hospital Medical Center (“Halifax”).  Judge Presnell ruled that Halifax failed to demonstrate that bonus compensation arrangements it made with medical oncologists satisfied a Stark Law exception.  Judge Presnell found … Continue Reading

Government Finds More Medical Services Unnecessary

In the September 2013 edition of the Cleveland Bar Journal, Colin Jennings and Tom Zeno described the government’s determination to challenge medical decision making as medically not necessary.   To read the article, visit Uncle Sam Becomes a Doctor:  Government Challenges to Medical Necessity. Recent prosecutions have been born out of their prediction. In October 2013, … Continue Reading

CMS Strengthens Policies to Encourage Automatic Assignment of Medicare Provider Agreements

In a policy memo published September 6, 2013, the Centers for Medicare & Medicaid Services (“CMS”) encouraged new owners of Medicare providers and institutional suppliers (“providers”) to accept automatic assignment of the seller’s Medicare Provider Agreement (“Agreement”) and CMS Certification Number (“CCN”).  The overall goal appears to be to encourage automatic assignment in Change of … Continue Reading

$762 Million Settlement by Amgen of Civil, Criminal, and Kickback Claims Approved by Judge

Yesterday, Amgen received approval of a global settlement from the federal judge in New York presiding over the criminal case filed against Amgen by the Department of Justice regarding the off-label promotion of the anemia drug Aranesp. The settlement resolves criminal charges and civil kickback claims filed by the federal government, claims of Medicaid fraud filed by 49 states … Continue Reading

CMS to Increase Payments to Primary Care Physicians in CY 2013

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will increase Medicare payments to primary care physicians by 7 percent and other practitioners providing primary care services between 3 and 5 percent.  This proposed payment increase is part of the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2013 and … Continue Reading

House of Representatives Introduces Bill to Stop Medicare Physician Fee Schedule Decrease

Given the scope of PPACA, many physicians were disappointed that Congress did not include a long-term fix to the Medicare sustainable growth rate formula.  As reported in an August 23, 2010 Annals of Internal Medicine article, White House officials acknowledged the physician disappointment, but said that “physicians should not let their frustration over the sustainable … Continue Reading

More Medicare Subrogation Issues Pending Before the Sixth Circuit Court of Appeals

Today, the United States Court of Appeals for the Sixth Circuit heard oral arguments in the appeal of Hadden v. United States, which involves questions of how much reimbursement Medicare can receive from tort/personal injury settlements.  The Eleventh Circuit in Bradley v. Sebelius recently decided the issue against Medicare, as we reported earlier. Now, it is the … Continue Reading

MSP Manual Not Entitled To Deference and Medicare Does Not Have Priority to Recover From Wrongful Death Settlement

In a decision that has garnered significant commentary, the United States Court of Appeals for the Eleventh Circuit recently held that the Medicare Secondary Payer (“MSP”) Manual is not entitled to deference in deciding the amount the Medicare program can recover from wrongful death settlements.  In doing so, the court rejected Medicare’s claim it could recover the … Continue Reading
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