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…

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…

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 Stark Exceptions for E-Prescribing and E-Health Records Final

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 Renal Physicians Association Lacks Standing To Challenge Stark Regulations

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.

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…