The Centers for Medicare and Medicaid Services (CMS) has issued new proposed fraud and abuse rules in accordance with requirements of the Affordable Care Act (ACA) — first known as the Patient Protection and Affordable Care Act (PPACA).
Section 6501(a) of ACA added Social Security section 1866(j), and required CMS to establish screening procedures for…
Section 6409 of the Patient Protection and Affordable Care Act (PPACA) required CMS to develop a Medicare Self-Referral Disclosure Protocol (SRDP) to facilitate the resolution of potential Stark violations. The SRDP was published on September 23, 2010 with two caveats:
1. Despite the fact that potential violations or situations might violate more than just the Stark…
New – Medicare Self-Referral Disclosure Protocol
CMS has published the self referral disclosre protocol required by ACA. Link and announcement below. Analysis will be posted next week.
Section 6409(a) of the Affordable Care Act (ACA) ACA requires the Secretary of the Department of Health and Human Services, in cooperation with the Inspector General of…
In OIG Advisory Opinion No. 10-14, the OIG concluded that it would not seek enforcement of the Anti-Kickback Statutes under an arrangement in which an independent sleep testing provider entered into an arrangement to provide a hospital-owned sleep testing facility with equipment and staff on a per test basis.
Physician Self-Referral
CMS proposes to implement changes enacted in ACA to the "whole hospital" and "rural provider" exceptions in the physician self-referral law that will prohibit their use by new physician-owned hospitals and limit the ability of existing physician-owned hospitals to expand their capacity. The deadline for physician investment and having a provider agreement…
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…
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…
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…
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…
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…
