The United States District in Kosenske v. Carlisle HMA Inc. has concluded that this whistleblower case must go to trial on the factual issue of whether Carlisle Hospital violated the False Claims Act by submitting claims for anesthesia services provided arising from referrals from Blue Mountain Anesthesia Associates (BMAA). Dr. Kosenske, the whistleblower in this case, … Continue Reading
Section 6003 of the Patient Protection and Affordable Care Act (PPACA), which is the 2010 Healthcare Reform Act, imposes a new disclosure requirement for in office ancillary service referrals of imaging services. Section 6003 requires that referrals of MRI, CT, PET, and other designated health services as specified by the secretary, must be accompanied by … Continue Reading
This is a Stark settlement that will send chills down the spines of hospital compliance officers. Rush Medical Center has entered into a Settlement Agreement with the DOJ, in which they agree to pay approximately $1.5 in False Claims Act Penalties. The settlement arose out of a qui tam (whistleblower) lawsuit filed in July 2004. The … Continue Reading
This is just a reminder of the effective date for certain new Stark Rules: 1. CMS prohibits percentage formulae conjunction with space on equipment leases, fair market value exception transactions and indirect compensation effective October 1, 2009. 2. Per click leases are prohibited effective October 1, 2009. 3. "Under arrangement" relationships have been changed because … Continue Reading
The U.S. Department of Justice issued a press release on August 25, 2009 announcing a $4.5 million False Claims Act Settlement against an Iowa hospital, Covenant Medical Center. The False Claims Act liability allegations were based upon charges by the Attorney General that paying excessive compensation violated the Stark Law. Based upon IRS 990 forms, the … Continue Reading
The Office of Inspector General of the Department of Health and Human Services has issued Advisory Opinion No. 09-05, which states that the OIG will not impose sanctions regarding a proposed on call arrangement in which the hospital will compensate physicians for providing on call coverage for patients presenting to the hospital or emergency department. The … Continue Reading
1 of 3 DOCUMENTS UNITED STATES OF AMERICA ex rel. TED D. KOSENSKE, M.D. v. CARLISLE HMA, INC.; HEALTH MANAGEMENT ASSOCIATES, INC., Ted D. Kosenske, M.D., Appellant NO. 07-4616 UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT 2009 U.S. App. LEXIS 971 October 31, 2008, Argued January 21, 2009, … Continue Reading
Third Circuit Decides Stark Exception Case in Qui Tam Context The Third Circuit Court of Appeals has rendered a provocative decision in the qui tam case, United States of America ex rel. Ted D. Kosenske, M.D. v. Carlisle HMA, Inc., which opinion was filed on January 21, 2009 and which is available at … Continue Reading
OIG issues another in a string of gainsharing opinions involving hospitals and groups of cardiologists and radiologists. This and the solicitation by HHS of comments on shared savings exceptions and safe harbors confirm HHS’s intent to continue to encourage legitimate cost savings and incentive programs. Link: http://www.oig.hhs.gov/fraud/docs/advisorgopinions/2008/AdvOpn08-21.2.pdf. … Continue Reading
Advisory Opinion 08-16, the text of which is linked below, involved a nonprofit hospital’s Pay for Performance (P4P) program with a commercial insurer and certain physicians on the hospital’s medical staff. Under the P4P program, the insurer pays the hospital bonus compensation calculated as percentage of the annual base compensation it otherwise pays to the … Continue Reading
The Department of Health and Human Services and Centers for Medicare and Medicaid Services (CMS) published final Stark IV regulations in the Federal Register on August 19, 2008. The web link is ttp://edocket.access.gpo.gov/2008/E8-17914.htm. The final regulations cover issues in addition to physician self-referral. Three issues of particular interest are the per-click compensation arrangements, the Stand-in-shoes regulations, and compliance … Continue Reading
Check David Harlow’s HealthBlawg ( http://healthblawg.typepad.com/) for a discussion of OIG Advisory Opinion 08-10, finding that a block leasing aggreement would be a prohibited joint venture.… Continue Reading
STARK: "STAND IN SHOES" REGULATIONS The original proposed physician "Stand in Shoes" regulations provide that any physician would stand in the shoes of any other doctor in the following circumstances: 1. Another physician who employs the referring physician; 2. His or her wholly owned professional corporation; 3. A physician’s medical practice that employs or contracts with … Continue Reading
CMS recently modified its website to include a new page called Frequently Asked Questions and just added twelve questions and responses under the Physician Self-Referral page. Access the FAQs. at http://www.cms.hhs.gov/PhysicianSelfReferral/05a_FAQs.asp#TopOfPage.… Continue Reading
On December 28, 2007, the Department of Health and Human Services Office of Inspector General (OIG) issued two advisory opinions approving gainsharing arrangements. Advisory Opinion 07-21 deals with cardiac surgeons and Advisory Opinion 07-22 with anesthesiologists. Consistent with prior gainsharing approvals… Continue Reading
2008 MEDICARE PHYSICIAN FEE SCHEDULE DELAYS STARK RULES CMS announced in the 2008 Medicare Physician Fee Schedule final rule that the following proposed revisions will not be finalized until the future publication of a final rule: § burden of proof; § obstetrical malpractice insurance subsidies; § unit of service (per click); § payments in lease … Continue Reading
The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has issued its fiscal year 2008 Work Plan, identifying investigation projects for the coming fiscal year relating to the Medicare and Medicaid programs. Following is a copy of pages 3 through 13 of the 2008 OIG Work Plan, which identify the … Continue Reading
MORE STARK III CHANGES: PHYSICIAN RECRUITMENT There have been a number of definitional or technical changes to the physician recruitment exception. · The definition of the hospital’s geographic service area, which was previously the area composed of these contiguous zip codes from which the hospital drew 75% of its inpatients, has been tweaked to exclude … Continue Reading
CMS ISSUES STARK ADVISORY OPINION PROHIBITING AMENDMENT OF RECRUITMENT AGREEMENT On October 3, 2007, the Centers for Medicare and Medicaid Services (CMS) issued Advisory Opinion CMS – AO – 2007 – 01 denying permission to the hospital and physician to revise a physician recruitment agreement. The proposed amendment would have deleted and “excess receipts provision, which … Continue Reading
OIG ADVISORY OPINION 07-10 APPROVES CALL PAY On September 27, 2007, the Office of the Inspector General of the Department of Health and Human Services posted OIG Advisory Opinion No. 07-10 which approves a tax exempt hospital proposal for compensating physicians for on call coverage. While acknowledging that on call compensation potentially creates considerable risk that … Continue Reading
STARK III REGULATIONS TEXT CMS issued the revised Stark III Regulations to be effective as of December 4, 2007. The text of the regulations is accessible at the link below, and the Med Law Blog will publish a number of short posts over the next two months highlighting certain changes prior to that effective date. The … Continue Reading
CMS Issues Final Stark Phase III Regulations Stark Phase III Regulations On August 27, 2007, the Centers for Medicare and Medicaid Services (CMS) placed on display at the Office of the Federal Register a final rule on physician "self-referral" of Medicare beneficiaries for certain types of Medicare-covered services. The rule is commonly known as "Stark … Continue Reading
Congressman Pete Stark has proposed a new piece to the Stark legislation which would eliminate the existing “whole hospital” exception for a physician ownership by inserting a provision into H.R. 3162, the Children’s Health and Medicare Protection Act, which would impose new hospital disclosure requirements and new physician ownership limitations. The text of the provision follows … Continue Reading
CMS has issued regulations within the intent of closing what it perceives to be loopholes in the Stark regulations. The major initiatives are as follows: 1. The definition of the term “entity” will be expanded to include both sole practitioners as well as other types of entities. The definition will state that an entity will include a … Continue Reading
