A new OIG Advisory Opinion 13-15, the OIG has resurrected the issue of whether awarding exclusive contracts to hospital based providers involves remuneration in exchange for referrals, because it grants the opportunity for access to an income stream.
In the text of OIG Advisory Opinion13-15, the OIG states as follows:
“The OIG has stated
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The House Ways and Means Committee and the Senate Finance Committee have jointly issued a White Paper proposing the repeal of the Medicare Sustainable Growth Rate Formula, entitled “SGR Repeal and Medicare Physician Payment Reform”.
The SGR white paper acknowledges that the Sustainable Growth Rate formula is “fundamentally broken” and that application…
In Granger v. Christus Health Central Louisiana d/b/a Christus St. Francis Cabrini, the Louisiana Supreme Court ruled that medical staff bylaws are a contract between the hospital and a the medical staff member. The court ruled:
“In promulgating the Bylaws and in accepting the applications of the physicians who sought medical staff membership in
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In OIG Advisory Opinion No. 13-03, the Office of Inspector General had the opportunity to deal with two issues which have always raised concerns in the past, i.e. pod labs and swapping. It is no surprise that OIG refused to issue a favorable advisory opinion regarding these issues, and one suspects the request was submitted…
HIPAA Omnibus Rule Compliance: Is Your Practice Ready?
On January 17, 2013, the United States Department of Health and Human Services released a Final Rule, commonly known as the “HIPAA Omnibus Rule,” which included significant changes to the HIPAA compliance requirements for healthcare covered entities, including private practice rehabilitation and medical providers. The compliance…
Highmark Launches Accountable Care Alliance
Attached is the press release;
https://www.highmark.com/hmk2/newsroom/pressreleases/2013/pr071813.shtml
More to come when the details are evaluaited.
Peer Review “Interference” Alleged as Tortious Interference with Contract
Many sham peer review cases are based upon breach of contract in states in which the medical staff bylaws are treated as contracts between the hospital and/or medical staff and the individual physicians. Typically, the cause of actions is based upon some failure to provide the…
CMS has issued the poroposed Medicare Physician Fee Schedule. Without Congressional intervention, the SGR will mandate a 24.4% decrease. CMS sent its calcuations to the Medare Payment Advisory Commission.
CMS has also issued a Fact Sheet Summary:
Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for DME
Due to concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of Durable Medical Equipment (DME), CMS will start actively enforcing…
Contributed by Lee Kim, Esq.
The CERT program is having a free all-day event tomorrow (June 26, 2013) in Pittsburgh, PA on security incident management for health information exchanges. This event is underwritten by the US Department of Health and Human Services.
Registration is free, but required. http://www.cert.org/cybersecurity-hie/. The event will be live and …
