Category Archives: Medicare

Family Medicine Centers of South Carolina Paid $2 Million to Settle Alleged Stark Law Violations Based on Internal Physician Compensation Approach

On September 11, 2017, the U.S. Attorneys’ Office for the District of South Carolina announced a settlement with the Family Medicine Centers of South Carolina based in part on allegations that the practice’s internal physician compensation approach violated the Stark Law, and resulted in the submission of false claims to the Medicare and Tricare programs. Family Medicine Centers are a physician-owned chain of family medicine clinics located in and around Columbia, South Carolina.

The allegations in this settlement arose from a lawsuit filed by a physician formerly employed by the Family Medicine Centers of South Carolina under the whistleblower provisions of the Federal False Claims Act. The allegations included the Stark Law was violated by the Family Medicine Center’s (FMC) incentive compensation plan that paid its physicians a percentage of the value of laboratory and other diagnostic tests that they personally ordered through FMC, and then FMC billed the Medicare program. According to the government’s press release, FMC’s physician ceo allegedly reminded FMC’s physicians that they needed to order tests and other services through FMC in order to increase FMC’s profits and to ensure that their take-home pay remained in the upper level nationwide for family practice doctors. Continue reading

OIG Announces August 2017 Work Plan Updates

The Office of Inspector General (OIG) recently announced on June 15, 2017 that it will be updating the OIG Work Plan on a monthly basis rather than as it previously did once or twice a year. The OIG’s Work Plan includes several projects that the OIG’s Office of Audit Services (OAS) and Office of Evaluation and Inspections (OEI) are currently undertaking or planning to undertake in the future. The topics and focus of these projects are often indicators of potential compliance risk areas for health care providers and other participants in the health care industry. Continue reading

CMS Urged to Recoup and Audit EHR Incentive Payments

According to a report released by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) on June 12, 2017, the Centers for Medicare and Medicaid Services (CMS) overpaid an estimated $729 million in Medicare electronic health record (EHR) incentive payments to participating providers. (The full report is available at https://oig.hhs.gov/oas/reports/region5/51400047.asp). The OIG reviewed whether CMS’ oversight of the Medicare EHR incentive program was sufficient and whether eligible professionals (EPs) nationwide met Medicare incentive payment program requirements and received appropriate incentive payments. Alarmingly, the OIG urged CMS to recoup and audit these incentive payments based on its findings. Participating EPs and hospitals should be cognizant of the ramifications of CMS’ recommendations, including the potential for an audit and recoupment. Continue reading

eClinicalWorks Case Raises New Questions

On May 31, 2017, the U. S. Department of Justice (DOJ) announced that eClinicalWorks (ECW) agreed to pay a $155 million settlement and enter a corporate integrity agreement with the OIG to resolve allegations that ECW caused its health care provider customers to submit false Medicare and Medicaid claims for meaningful use payments in violation of the False Claims Act (FCA). Under the corporate integrity agreement, ECW agreed to strict compliance and reporting obligations and to provide the latest version of ECW’s EHR software to each of ECW’s current customers free of charge. Continue reading

OIG Corporate Integrity Agreements and Physician Compliance Programs

In settling allegations of violating the False Claims Act (FCA), healthcare providers often enter into a Corporate Integrity Agreement with the OIG in exchange for the OIG’s agreement not to exclude the provider from participation in Medicare or other federal health care programs. Corporate Integrity Agreements (CIAs) generally require a provider to establish or supplement an existing compliance program, with detailed requirements described in the CIA. Continue reading

New York Whistleblower Court First to Address What It Means to “Identify” Overpayment under ACA’s 60 Day Rule

For the first time since its enactment as part of the Affordable Care Act (ACA) in 2010, a federal court in a whistleblower action will consider a provision requiring providers to return overpayments within sixty days of when they are “identified.”  The upcoming decision by the United States District Court for the Southern District of New York in U.S. ex rel. Kane v. HealthFirst Inc. et al  will likely be just  the first of many decisions on the subject.   Providers and government regulators are poised for what could prove a lengthy dispute at both the trial and appellate levels around the ACA’s 60 day rule and its interplay with overpayments in the False Claims Act (FCA) context. Continue reading

ICD-10 Delay Update

The house bill (HR 4302) delaying implementation of ICD-10 moved quickly through the Senate on Monday and was signed by President Obama on Tuesday. The ICD-10 delay, which was included in a much broader bill to delay Medicare payment cuts to doctors, prohibits the Centers for Medicare and Medicaid Services (CMS) from enforcing any mandate to switch from ICD-9 to ICD-10 until at least October 1, 2015. Since the language focuses on preventing CMS from enforcing a mandate, several questions remain including whether October 1, 2015 is the new deadline for implementation.

Written by: Traci Thompson

 

House Passes ICD-10 Delay Bill

The U.S. House of Representatives passed a bill on March 27 that would delay the ICD-10 implementation deadline by one year to October 1, 2015. A similar bill in the Senate is expected to be voted on soon. The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, also adjusts Medicare’s sustainable growth rate (SGR) formula to prevent the 24 percent cut to physician reimbursement rates scheduled to begin April 1. Medicare payment cuts to physicians would be delayed until April 1, 2015.

Opposition to the bill focuses on the need for a permanent replacement of the Medicare physician payment system instead of the proposed one year “patch” currently being considered. Opponents of the ICD-10 implementation provision claim that the delay could cost the industry billions of dollars. Others support the measure noting that providers are not prepared for the October 1, 2014 implementation.

Written by: Traci Thompson

The New Two-Midnight Rule – Scrutiny Delayed for 90 Days

The Center for Medicare and Medicaid Services (CMS) released what has become known as the “Two Midnight Rule” on August 2, 2013 in the Inpatient Prospective Payment System (IPPS). The Final Rule is available in the August 19, 2013 Federal Register.
Last week, in response to provider concerns and a letter from more than 100 members of Congress asking for postponement of the rule, CMS announced a 90 day implementation period beginning on October 1, 2013. Continue reading

Overturning of DOMA Has Implications for Medicare Benefits of Same-Sex Couples

On Thursday, August 29, in response to the Supreme Court overturning a key portion of the Defense Of Marriage Act (DOMA), a handful of agencies announced they would be extending rights to married same-sex couples. Notably, the Department of Health and Human Services (HHS) is one of them. This development means an extension of Medicare benefits to couples previously denied Medicare benefits because of DOMA. Same-sex married couples will be allowed to file joint federal tax returns, and as a result are able to claim marriage-related exemptions, employee benefits, claiming the earned income tax credit and other credits and deductions even if they live in jurisdictions that don’t recognize same-sex marriage. Continue reading