Oops, They Did It Again: Will Your Medicare Part B Reimbursement Decrease?
Posted by donna@healthlawcenterplc.com in Sep, 2018
Every year the Centers for Medicare and Medicaid Services proposes Medicare Part B reimbursement rules for the upcoming year. The 2019 proposed rule changes could affect the amount of reimbursement physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists receive. If these proposed rules are finalized, clinicians could lose as much […]
Are You Defrauding Medicare By Either Upcoding Or Downcoding Submitted Claims?
Posted by donna@healthlawcenterplc.com in Aug, 2018
Both upcoding and downcoding are significant because these actions have been interpreted as a basis for abusing and defrauding the federal government and its programs. According to CMS, “abuse describes practices that, either directly or indirectly, result in unnecessary costs to the Medicare Program.” Abusive coding practices include: Upcoding – a code with a […]
Patients Can Not Sue For Breach Of HIPAA Privacy Rule
Posted by donna@healthlawcenterplc.com in Jul, 2018
The United States District Court is the most recent court to rule on whether a patient has a right to sue a health care provider when the privacy of protected health information is breached. Consistent with previous court decisions, the U.S. District Court for the District of Columbia concluded that HIPAA does not grant […]
Category: HIPAA
Post Tagged with Centers for Medicare & Medicaid Services, Donna Craig, HIPAA, Privacy Rule, The Health Law Center Now’s Your Chance To Tell CMS How You Feel About The Stark Law!
Posted by donna@healthlawcenterplc.com in Jul, 2018
The Centers for Medicare & Medicaid Services (“CMS”) is seeking public input on how the Stark Law may be impeding patient care coordination. CMS issued a “Request for Information” seeking comments from providers that participate in alternative payment models (value based programs vs. fee for service) that may require the need to revise or […]
Category: Medicaid, Medicare, News & Updates
Post Tagged with Centers for Medicare & Medicaid Services, Donna Craig, Medicare, Stark Law, The Health Law Center Texas Supreme Court Finds Xerox, Not Dentists, Responsible For Fraudulent Medicaid Dental Payments
Posted by donna@healthlawcenterplc.com in Jul, 2018
The Texas Supreme Court recently upheld a Texas Court of Appeals ruling that Xerox was responsible for the $1 billion in fraudulent Medicaid dental payments. The state found that Texas Medicaid and Healthcare Partnership, a subsidiary of Xerox, allowed workers with limited expertise to approve dental claims for the state’s Medicaid program. Xerox, which was […]
Category: Anti-Kickback Statute, Medicaid, News & Updates
University Of Texas MD Anderson Cancer Center Must Pay More Than $4.3 Million For HIPAA Violations
Posted by donna@healthlawcenterplc.com in Jun, 2018
An Administrative Law Judge (ALJ) ruled that MD Anderson Cancer Center must pay more than $4.3 million in civil monetary penalties for violating HIPAA Privacy and Security Rules. The ruling is based on three separate data breaches in 2012 and 2013 that involved the theft of an unencrypted laptop from a MD Anderson physician’s home […]
Category: HIPAA
Post Tagged with Centers for Medicare & Medicaid Services, Donna Craig, HIPAA, Privacy Rule, Security Rule, The Health Law Center Physician And Two Nurses Found Guilty of $13 Million Home Care Fraud Scam
Posted by donna@healthlawcenterplc.com in Jun, 2018
Dr. Kelly Robinett a semi-retired emergency room doctor with more than 30 years of experience was convicted of fraud for his role in a $13 million home health care scam. After a weeklong trial before U.S. District Judge Reed O’Connor in Dallas, the jury issued its verdict after several hours of deliberations. Along with […]
Category: Anti-Kickback Statute, Medicare, News & Updates
Pfizer to Pay $23.85 Million for Alleged Violations of the Anti-Kickback Statute
Posted by donna@healthlawcenterplc.com in Jun, 2018
Pfizer was alleged to have used a tax exempt, non-profit foundation as a conduit to pay drug co-pays for Medicare patients who were either prescribed two Pfizer drugs for the treatment of renal cell cancer (Sutent and Inlyta) or another Pfizer drug for the treatment of atrial fibrillation or atrial flutter (Tikosyn). The Anti-Kickback […]
Category: Anti-Kickback Statute, Medicare, News & Updates
Post Tagged with Centers for Medicare & Medicaid Services, Fraud & Abuse, Medicare, Physician, The Health Law Center Become More Efficient With EHR, Leaving More Time With Patients
Posted by donna@healthlawcenterplc.com in Jun, 2018
Medical Economics provides guidance to healthcare providers to help in improving their efficiency with EHR documentation. Being more efficient leaves more time for the patients. “The healthcare industry has been ready for an overhaul of the Meaningful Use program, and the Centers for Medicare & Medicaid Services is prepared to deliver. What can physicians expect? […]
CMS Proposed Rule For Short-Term, Limited Health Insurance: Would You Get The Coverage You Expect?
Posted by donna@healthlawcenterplc.com in May, 2018
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that seeks to expand the sale and use of short-term, limited duration health insurance plans (“skinny health plans”), by extending the maximum duration of such plans from three months to twelve months. These types of health insurance plans by definition are not required to […]
Category: Medicare
Post Tagged with Affordable Care Act, Centers for Medicare & Medicaid Services, Medicare, The Health Law Center 
