Fraud - Stark

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The 2011 Medicare Physician Fee Schedule adds an additional requirement to the in-office ancillary services exception of the Stark Rules. New Section 411.355(b)(7) requires that providers of MRI, CT and PET services must provide a written notice to the patient at the time of the referral, advising that the patient may receive the same services from…

The Centers for Medicare and Medicaid Services (CMS) has issued new proposed fraud and abuse rules in accordance with requirements of the Affordable Care Act (ACA) — first known as the Patient Protection and Affordable Care Act (PPACA). 

Section 6501(a) of ACA added Social Security section 1866(j), and required CMS to establish screening procedures for…

Section 6409 of the Patient Protection and Affordable Care Act (PPACA) required CMS to develop a Medicare Self-Referral Disclosure Protocol (SRDP) to facilitate the resolution of potential Stark violations. The SRDP was published on September 23, 2010 with two caveats:

1.         Despite the fact that potential violations or situations might violate more than just the Stark…

New – Medicare Self-Referral Disclosure Protocol

CMS has published the self referral disclosre protocol required by ACA. Link and announcement below. Analysis will be posted next week.

Section 6409(a) of the Affordable Care Act (ACA) ACA requires the Secretary of the Department of Health and Human Services, in cooperation with the Inspector General of…

Physician Self-Referral

CMS proposes to implement changes enacted in ACA to the "whole hospital" and "rural provider" exceptions in the physician self-referral law that will prohibit their use by new physician-owned hospitals and limit the ability of existing physician-owned hospitals to expand their capacity. The deadline for physician investment and having a provider agreement…

The United States District in Kosenske v. Carlisle HMA Inc. has concluded that this whistleblower case must go to trial on the factual issue of whether Carlisle Hospital violated the False Claims Act by submitting claims for anesthesia services provided arising from referrals from Blue Mountain Anesthesia Associates (BMAA). Dr. Kosenske, the whistleblower in this…

This is just a reminder of the effective date for certain new Stark Rules:

1.         CMS prohibits percentage formulae conjunction with space on equipment leases, fair market value exception transactions and indirect compensation effective October 1, 2009.

2.         Per click leases are prohibited effective October 1, 2009.

3.         "Under arrangement" relationships have been changed because…

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