Category: Medicare

Concierge Medicine Impact of Physician Ethical Obligations on Structure

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How Ethics Shape the Design and Delivery of Concierge Medicine Concierge Medicine Introduction Concierge medicine has emerged as a popular healthcare model, offering patients enhanced access, personalized care, and a variety of premium services in exchange for membership fees. While this approach...

Telemedicine IT Donations and the Anti-kickback Statute OIG Opinion 18-03

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Overview of the OIG Advisory Opinion No. 18-03 The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued Advisory Opinion No. 18-03 regarding an arrangement in which a federally qualified health center look-alike (the “Provider”) proposes to donate informati...

Remuneration Under the Stark Law I Stark Regulations Definition

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Remuneration Defined Under the Stark Law Regulations Remuneration means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind, except that the following are not considered remuneration for purposes of this section: (1) The forgiveness of amounts owed fo...

Can Overpayments Create Criminal Liability?

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We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges for retaining known overpayments.  Section 1128B(a)(3) of the Social S...

Ambulatory Surgery Center Forced Exclusions – lets be honest for a minute, shall we?

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Excluding Non-performing Positions from a Physician Owned Surgery Center   Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedure procedures in the surgery center as others.  Under-performing physicians can create pol...

Special Rules on Compensation Stark Law

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Stark Regulations Special Rules On Compensation (d) Special rules on compensation. The following special rules apply only to compensation under section 1877 of the Act and subpart J of this part: (1) Compensation is considered “set in advance” if the aggregate compensation, a time-based or per-un...

Ambulatory Surgery Center Structural and Valuation Issues

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ASC Regulatory and Structural Issues   A recent “advanced session” was provided by the American Health Lawyer’s Association covering several of the central legal issues that arise with respect to ASC ownership and structure.  The general issues covered in the webinar included:   1.A...

Bad Anesthesia Billing Advice Can Lead To False Claims

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Beware Of Bogus Anesthesia Billing Advice I wanted to alert anesthesia groups to what I consider to be some very bad advice that is being provided by some billing consultants.  If taken, the advice could put your group in the midst of a lawsuit with a third-party payor or even a claim of insura...

Medicare Fraud & Abuse: Prevention, Detection, and Reporting MLN Fact Sheet

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The Medicare Learning Network has been updated to include a new publication entitled “The Medicare Fraud & Abuse: Prevention, Detection, and Reporting Fact Sheet” (ICN 006827). The new Fact Sheet provides information on how providers can ensure Medicare enrollment records are current, safe and se...