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Telemedicine Special Fraud Alert

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.  The alert is based upon OIG’s perception that these Telemedicine Companies are engaged in schemes to … Continue Reading

Mike Cassidy Published in the Allegheny County Medical Society’s Signature Publication

Mike Cassidy recently wrote an article entitled, “Private Equity Deals Offer Both Potential Significant Return and Significant Challenges” in the Legal Summary section of the July 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to … Continue Reading

Tucker Attorneys Jeremy Farrell and Rebecca Moran Published in the Allegheny County Medical Society’s Signature Publication

Jeremy Farrell and Rebecca Moran recently wrote an article entitled, “Pregnancy-Related Protections for New Physicians” in the Legal Summary section of the June 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article … Continue Reading

HHS Requesting Physician COVID Relief Payback of $100 Million

HHS sent notices to noncompliant physicians and facilities on March 10, 2022 giving them 30 days to return funds paid to healthcare providers who have not complied with the agency’s reporting requirements.  Attach is the PDF from HRSA (Health Resources and Services Administration), which is the agency responsible for dispensing and collecting the grant money. … Continue Reading

Congress Extends Telehealth Coverage

The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief. On Tuesday, March 15, 2022, President Biden signed the Consolidated Appropriations Act, 2022 (“2022 CAA”).  This new law includes several provisions that extend the Medicare telehealth waivers and flexibilities, implemented as a result of COVID-19 to … Continue Reading

Highmark Fraud Waste and Abuse Results

Highmark Health issued a Press Release on February 7, 2022 announcing that it’s Financial Investigations and Provider Review (FIPR) department generated more than $245 million in savings related to fraud waste and abuse in 2021, the majority of which was in Pennsylvania–$184 million. Click here to see to what the Highmark FIPR Department has identified … Continue Reading

2022 Medicare Rules for Facility-Based Split/Shared Visits

There has been much discussion and controversy over the new CMS position on billing for split/shared services in facility settings. As originally proposed, and starting in January 2022, if the service was shared among providers (such as physicians and physician assistants), the provider who performed the substantive portion of the visit would be the provider … Continue Reading

2022 Federal Compliance Enforcement Outlook

There is almost universal agreement regarding predictions for 2022 federal enforcement in the following areas: The use of fraudulently obtained COVID relief funds in both healthcare and in general, but specifically as a foundation for False Claims Act enforcement. Furthermore, the reinstatement of the Yates memo of 2015 by the Deputy Attorney General Lisa Monaco’s … Continue Reading

“Stark” Rules: Navigating Physician Leases and Subleases

Under the Federal Ethics in Patient Referrals Act (more commonly known as “Stark”), if a physician[1] has a financial relationship with an entity, the physician may not refer patients to the entity for medical services payable by Medicare unless the financial relationship complies with the Stark safe harbors.  Thus, entities that lease or sublease space or … Continue Reading

CMS Policy Summary: 2022 Medicare Physician Fee Schedule, Telehealth Originating Site Facility Fee and Services List, and Physician Assistant Billing

In MLN Matters article MM 12159, CMS has published summaries of the following: Updates to payment policies and Medicare payment rates for services provided by physicians and non-physician practitioners (NPP) Updates to Medicare telehealth services and telehealth originating site facility fee payment amounts Billing for a physician assistant (PA) services  … Continue Reading

Will AI Work for Diagnostic Medicine?

A recent Wall Street Journal article in their “The Future of Everything” commentary stream discusses the use of artificial intelligence (AI) to “tap the treasure trove of information locked in electronic health records to treat people in real time”. An interesting concept.  Not all that long ago this would have been disparaged as “cookie-cutter medicine”.  … Continue Reading

Mandatory COVID Vaccine for Healthcare Workers

The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule requiring COVID-19 vaccinations for workers in most institutional care settings.  A copy of the CMS press release can be found at https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care. This rule applies to those facilities subject to CMS regulations. Several facilities are regulated by the CMS, but this does … Continue Reading

PA Senate Approves Another Telemedicine Bill

The Pennsylvania Senate announced on October 26, 2021 that it has passed Senate Bill 705, and a copy of the Senate Press Release can be found at https://www.pasenategop.com/blog/senate-approves-telemedicine-bill/. A previous telemedicine bill was passed in Pennsylvania in July of 2018, when the Pennsylvania Senate approved Bill 780, which was discussed in my MedLaw Blog article … Continue Reading

Medical Practices Face Liability for COVID Accelerated and Advance Payments and PPP Loans

Medical practices are now beginning to encounter Medicare payment claw backs by CMS for COVID Accelerated and Advanced Payments (CAAP) and Department of Justice (DOJ) prosecution for Paycheck Protection Program (PPP) abuses. Please check the following links below for additional information. Justice Department Takes Action Against COVID-19 Fraud: Justice Department Takes Action Against COVID-19 Fraud … Continue Reading
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