The United States Court of Appeals has decided that the Renal Physicians Association (RPA), a national professional association, does not have legal standing to challenge the legality of the Stark Regulations. RPA had asserted that certain of the Stark regulations defining fair market value and personal service arrangements for purposes of establishing exceptions to the … Continue Reading
The Office of Inspector General (OIG) has issued advisory opinion number 07-05 concluding that a proposal by a group of physicians owning an ambulatory surgery center to sell 40% of the ambulatory surgery center to a hospital has the potential to generate unlawful remuneration and is therefore not eligible for a safe harbor advisory opinion. The … Continue Reading
The California Department of Insurance and the Orange County District Attorney’s Office have arrested three doctors in what they are describing as the largest medical fraud prosecution in the nation. Some stories are so abhorrent they taint entire professions. In Orange County, three physicians and a group of ambulatory surgery center developers, some of whom have already … Continue Reading
Two former employees of East Tennessee Heart Consultants, a forty physician cardiology practice in Tennessee, tipped off federal prosecutors, who then filed a qui tam claim alleging the cardiology practice had a policy of retaining overpayments for services provided unless refunds were specifically requested, and that the practice maintained its billing records to conceal the … Continue Reading
The final rules for the Stark excetions allowing entities to provide non_monetry assistance for electronic health records and e-prescribing systems were issued in final form and are avaialable on the CMS web site mentioned in the press release reproduced in the MedLaw Blog.… Continue Reading
The U.S. District Court from the District of Columbia ruled on March 7, 2006 that the Renal Physicians Association (RPA), a national non-profit specialty society of dialysis facility medical directors, lacked standing to challenge the Stark regulations regarding fair market value compensation.… Continue Reading
For those who doubt the possibility of OIG enforcement regarding fraud and abuse violations, the OIG Semi-Annual Report lists the following enforcement results: $2.8 billion on audit and investigative receivables; 3,806 individual and entity; receivables; 537 criminal actions; and 262 civil actions The report is accessible on the OIG Web site.… Continue Reading
The final rule from the Medicare Physician Fee Schedule revises the Stark definition of designated health services (DHS) to include diagnostic and therapeutic nuclear medicine services. Since this change will impact existing relationships, this portion of the rule has a delayed effect date, i.e. January 1, 2007. Fee Schedule: Nuclear Medicine: DHS (CMS’s discussion on … Continue Reading
CMS Issues Stark Advisory Opinion Stating That Stock Interest In Non-Profit Practice Organization Is Not A Stark Financial Interest CMS has determined that stock held by physician shareholders in a 700 physician non-profit group medical practice does not constitute a financial interest for purposes of Stark, so that it would not prohibit referrals by the … Continue Reading
