On October 27, 2014, the Governor signed Pennsylvania General Assembly enacted House Bill 1846, which limits both the authority and the reimbursement of physicians and providers other than pharmacies for prescription drugs. It provides as follows:
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In United States ex rel. Martin et al. v. Life Care Centers of American, Inc., the Court held that the government could extrapolate from a random sample in order to impose False Claims Act (FCA) liability against Life Care Centers of American Inc. (Life Care) for a substantially larger universe of claims.
In order…
Michael Cassidy was recently appointed as counsel for the Allegheny County Medical Society (ACMS). More information can be found at the below link.
In Kates v. Doylestown Hospital, the Pennsylvania Superior Court, in a non-precedential decision, held back the Pennsylvania Peer Review Protection Act does not provide confidentiality protection for certain records, stating:
Peer review necessarily involves evaluating the quality of care provided by medical professionals or evaluating the qualifications of medical care providers. 0045cept for those
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CMS has announced its concern regarding the level of compliance for documenting the face-to-face elements necessary for home health care certification.
Attached is an educational piece published by Novitas Solutions on its Part B website.
It lists the qualification criteria for home health benefits:
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It should come as no surprise there are cases in which hospitals seek to and actually do recover income guarantee payments made to physicians whom, either through termination of employment or loss of hospital privileges, fail to fulfill the repayment requirements existing in most of those contractual arrangements.
They typical hospital guarantee arrangement provides advances…
In OIG Advisory Opinion 14-06, the Office of Inspector General (OIG) concluded that payment by a specialty pharmacy to a retail pharmacy on a “per-fill” basis for services provided by the retail pharmacy could violate the Anti Kickback Statute and Civil Money Penalty provisions.
The specialty pharmacy, as the requestor, proposed to pay retail…
Community Health Systems announced today, August 18th, that hackers broke into its computers and stole data on 4.5 million patients. The information included names, Social Security numbers, physical addresses, birthdays and telephone numbers. More information on the breach is available at http://money.cnn.com/2014/08/18/technology/security/hospital-chs-hack/index.html
It is ironic to learn the Office of Inspector General (OIG) believes the Office of the National Coordinator for Health Information Technology (ONC) essentially has an insufficient compliance program to maintain the privacy and security of the protected health information (PHI) hosted by electronic health records (EHR).
In an August 2014 report (A-06-11-00063), OIG concluded…
