EXECUTIVE SUMMARY: QUESTIONABLE BILLING FOR MEDICARE INDEPENDENT DIAGNOSTIC TESTING FACILITY SERVICES
OEI-09-09-00380
WHY WE DID THIS STUDY
Independent Diagnostic Testing Facilities (IDTF), a type of Medicare provider, offer diagnostic services and are independent of physicians’ offices or hospitals. IDTF services have historically been vulnerable to abuse. In 1997, the Office of Inspector General found that…
Contributed by: Lee Kim, Esq.
412.594.3915
The ONC Health IT Mobile Devices roundtable is being aired today, on March 16, 2012, by way of live video webcast at http://www.hhs.gov/live.
Here are my thoughts upon hearing the content (which is certainly instructive and helpful) (and this was submitted to ONC Health IT for public comment):
1.
Contributed by: Lee Kim, Esq.
412.594.3915
The HITECH Breach Notification Rule requires covered entities to report an impermissible use or disclosure of protected health information, or a “breach,” of 500 individuals or more to HHS and the media. Smaller breaches affecting less than 500 individuals must be reported to the secretary on an annual basis. …
The Commonwealth Fund published a recent report ranking 306 communities on 43 measures of health system performance. The title of the report is “Improving Health Care from the Ground Up” and can be accessed at www.commonwealthfund.org.
I have attached the ranking of the Pittsburgh community and was somewhat surprised to see it ranking in the…
In Edwards v. Geisinger Clinic the Third Circuit held that a health clinic’s statement to a physician and to immigration officials regarding a physician’s “at least three year” employment did not create an employment contract.
A physician took a job with a health clinic with the understanding that he must work at the clinic for…
The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) and the Office of Inspector General have posted a Toolkit consisting of a series of podcast training videos on the following subjects:
· How to Use the Exclusions Database
· How to Report Fraud to the OIG
· OIG’s Self-Disclosure Protocol
· …
A Federal Court denied prevailing party attorneys’ fees to a hospital in a Health Care Quality Improvement Act (HCQIA) proceeding and allowed the hospital to design its own due process in Fox v. Good Samaritan Hospital.
The denial of the attorneys’ fees is basically based upon laches and estoppel theory, because the hospital waited…
Contributed by: Lee Kim, Esq.
412.594.3915
CMS has released the notice of proposed rulemaking for meaningful use stage 2 and has provided an overview fact sheet outlining the differences from stage 1.
Link to NPRM:
http://www.ofr.gov/OFRUpload/OFRData/2012-04443_PI.pdf
Link to fact sheet:
The Health Care Compliance Association says that, “The CHC© is a professional with knowledge of relevant regulations and expertise in compliance processes sufficient to assist the health care industry to understand and address legal obligations, and promote organizational integrity through the operation of effective compliance programs.”
Michael Cassidy, chair of the Health Care…
Section 6402(a) of the Affordable Care Act established a new Section 1123J(d) of the Social Security Act entitled “Reporting and Returning Overpayments.” This new provision requires a person who has received an overpayment to report and return the overpayment, and to provide written notification for the reason of the overpayment. On February 16, 2012, CMS published the…
