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Shakespeare on Medical Staff Credentialing

Who says a background in English literature has no practical value? Certainly not the attorneys defending Dimensions Health in a class action filed on behalf of patients treated by an OB/GYN on the Dimensions medical staff....more

You-Can’t-Make-this-Up Award

From time to time a development in health law confirms the adage that truth is stranger than fiction. That’s why we hand out the You-Can’t-Make-this-Up Award for real life developments that seem to defy the imagination....more

CMS Gamed System to Identify Hospitals Gaming System?

You can’t make this stuff up. When CMS conducted a study to identify hospitals that game the quality data reporting system, it used an approach that made the data reporting look better than it actually was. That bottom line...more

Medicare Appeal Proposal Falls Far Short of Court Mandate

For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting...more

CMS Report Blasts Provider Directory Errors

A new report by CMS echoes many patients in criticizing Medicare Advantage (MA) online provider directories for containing too many errors. “Online Provider Directory Review Report” concludes that too often a directory entry...more

Qualifications for Artificial Limb Suppliers, After Only 16 Years

Bill Clinton was President when Congress enacted a law requiring CMS to come up with qualifications for those who make or supply artificial limbs to Medicare patients. It was January 11, 2017, when CMS finally unveiled the...more

Do CMS Ratings Punish Hospitals for Serving the Poor?

Does the CMS star rating system reward hospitals for serving the affluent and punish those that serve the poor? The answer is a resounding yes, according to a recently published analysis by Bloomberg BNA. The analysis...more

The Law Doesn’t Forbid Submitting False Claims

An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims. That made all the difference in an appeal of summary judgment in...more

Hold it, Doctor! Don’t Hit the Send Button!

The Joint Commission made a big splash when it issued its “Update: Texting Orders” back in the spring. That Update rescinded the accrediting organization’s long-standing prohibition on sending physician orders via text...more

Same Per-Click Rule, New Rationale

On July 7 CMS issued a proposed rule reaffirming its position that the Stark Law prohibits “per-click” rent payments when the lessor is the one referring the patients to the lessee for the “click,” e.g., the test or...more

And You Thought RAC Audits Couldn’t Get Any Worse

If there’s one thing that unites the hospital industry—even the fiercest competitors—it’s hatred of audits by recovery audit contractors, or RACs. Why? For one thing, because RACs operate on a contingency fee basis. They...more

Court Rejects End-Run of Medicare Appeals Rules

The Indiana Health Department sent a team to the Nightingale home health care and hospice group, in response to complaints. When CMS received the team’s report, it notified Nightingale that its Medicare certification was...more

Finally, A Final Rule on ACA's 60-Day Repayment Rule

On February 11, 2016, the Centers for Medicare & Medicaid Services (CMS) released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA)...more

Further CMS Clarification on EHR Hardship Exceptions

As we reported, the Centers for Medicare & Medicaid Services (CMS) posted revised instructions and application forms on January 22, 2016, for health care providers unable to meet electronic health records (EHR) “meaningful...more

Was Whistleblowing a Reason for Firing or the Reason?

The outcome of a physician whistleblower’s retaliation claim against his former medical group turns on the question whether whistleblowing was a reason or the reason he was fired. If it was a reason, he loses. If it was the...more

Deadline Looms for EHR Hardship Exceptions

The Centers for Medicare & Medicaid (CMS) expect 209,000 health care providers to face Medicare payment reductions for failing the electronic health records (EHR) “meaningful use” requirements in 2014. CMS puts the estimated...more

Two More Hospitals Qualify for Exception to Exception to Grandfather Exception to Elimination of Whole Hospital Exception to Stark...

The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest. There used to be a “whole hospital exception” excluding entire hospitals (as...more

Brace Yourself for another Round of Death Panel Debate

Remember the notorious “death panel” debate of 2009? Congress was considering a proposal to pay doctors for end-of-life counseling. Former vice presidential candidate Sarah Palin led the attack on the proposal, claiming...more

New CMS Ruling on DSH Appeals for FY 2004 and Earlier

It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued...more

OIG Wants CMS to Take a Scalpel to Surgery Costs

The Office of Inspector General (OIG) of Health & Human Services is recommending that CMS make a major reduction to the amount it pays hospitals for certain kinds of surgery. ...more

Black Tuesday Falls on a Friday for Nation’s Nursing Homes

If you think of CMS quality ratings as the Dow Jones index, then last Friday, February 20, was the equivalent of Black Tuesday, October 29, 1929, the day the stock market collapsed. Why? ...more

QNHII Regs Due Thursday—After Only Five Years

When the Affordable Care Act (ACA) was signed into law back in 2010, it directed the Centers for Medicare & Medicaid Services (CMS) to establish the Consumer Operated & Oriented Program (CO-OP). The point of the CO-OP is to...more

CMS Announces Goals and Timeline for Shift to Value-Based Medicare Payments

On January 26, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a news release reporting Health & Human Services (HHS) Secretary Sylvia Burwell’s announcement earlier in the day of measurable goals and a...more

CMS Announces 20 Repairs to RAC Program

Ever face the choice between trading in your old car or paying for multiple repairs? CMS faced that kind of choice with its Recovery Audit Contractor (RAC) program. Under the RAC program, contract auditors audit hospitals...more

Pain Clinic Sues CMS Over $25 Million Repayment Demand

Alabama Pain Center thought it knew all about pain, but nothing had prepared it for the bill it received when CMS decided to retroactively “reprice” certain compounded drugs: $25 million....more

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