New Provider and Supplier Enrollment Requirements To Take Effect June 20, 2006
On April 21, 2006 the Centers for Medicare and Medicaid Services (“CMS”) published a Final Rule setting out CMS’ requirements for providers and suppliers to establish and maintain Medicare enrollment...
View ArticleCMS Comes Down Hard on State Medicaid Fraud Enforcement Efforts
In a recent report, the Centers for Medicare and Medicaid Services (CMS) slammed the State of New York, which administers the largest Medicaid program in the nation, for having an ineffective Medicaid...
View ArticleNew Hospital Conditions of Participation to Take Effect January 26, 2007
The Centers for Medicare & Medicaid Services has published a final rule revising and updating the conditions of participation (“CoP”) requirements affecting medical staff, nursing services, medical...
View ArticleErnst & Young Report to IRS Reveals Tax-Exempt Hospitals' Community Benefits...
In a November 27, 2006 report commissioned by the American Hospital Association and sent to the Internal Revenue Service, Ernst & Young determined that 132 tax-exempt hospitals that had previously...
View ArticleOut With Thompson - In With McNulty: Department of Justice Issues New...
U.S.Deputy Attorney General Paul J. McNulty issued a Memorandum yesterday on the Principles of Federal Prosecution of Business Organizations (the "McNulty Memo"). The McNulty Memo expressly states that...
View ArticleCMS Letter to State Medicaid Directors Offers Much-Needed Guidance on DRA...
As most health care providers are by now well aware, Section 6032 of the Deficit Reduction Act of 2005 provides that, by January 1, 2007, every entity that receives or makes annual payments of at least...
View ArticleCMS Extends Deadline For Publication of Final Stark II, Phase III Rule
As expected, CMS announced today that it is extending the timeline for publication of the final rule implementing the Stark Law (the “Phase III Rule”) for one year. With this extension, the interim...
View ArticleOIG Will Engage in Unannounced Site Visits to Ensure Compliance With CIAs
On April 23, the Department of Health and Human Services, Office of Inspector General (OIG), indicated that it will begin engaging in unannounced site visits to providers operating under corporate...
View ArticlePRRB Rules In Favor of Hospital on Bad Debt Issue
In a decision dated April 19, 2007, the Provider Reimbursement Review Board ("the Board") soundly rejected the "extrapolation policy" that had been applied to the bad debts of St. Francis Hospital of...
View ArticleHospital Credentialing of Medical Device Sales Representatives – Increasing...
Legal concerns surrounding the credentialing of health care industry representatives (“HCIRs”) will continue to increase as more and more hospitals implement credentialing programs and those who...
View ArticleHot Fraud and Abuse Issues for Medical Device Companies
Federal enforcement authorities are focusing on key fraud and abuse issues in the medical device industry -- safety-related reporting and fraud risks, kickbacks, device alteration and off-label...
View ArticleOIG Advisory Opinion 07-05: How a Fair Market Value Deal Can Place...
In an Advisory Opinion released June 19, 2007, (OIG Advisory Opinion No. 07-05), the Department of Health and Human Services Office of Inspector General (“OIG”) made clear its disdain for the partial...
View Article2008 Physician Fee Schedule Proposes A Host of Stark Law Revisions - And It...
CMS issued the Proposed CY 2008 Medicare Physician Fee Schedule on July 2, 2007 (the “Proposed Rule”). Not only does this Proposed Rule establish several physician payment reforms, it also proposes to...
View ArticleLong-Awaited Stark Law Phase III Final Rule Released By CMS
On August 27, 2007, CMS released the final rule that constitutes the third phase (“Phase III”) of the long, drawn out rulemaking process relating to the Federal physician self-referral prohibition (the...
View ArticleOIG Opines On Propriety of ED Call Coverage Arrangements
On September 27, 2007, the Office of Inspector General (“OIG”) published Advisory Opinion No. 07-10, in which the OIG concluded that it would neither exclude from Federal health care program...
View ArticleSTARK II PHASE III: A Detailed Section-By-Section Analysis of the...
The Crowell & Moring Health Care Group is pleased to provide our clients, colleagues, and friends with our legal analysis of the Stark II Phase III Regulations, recently published in the September...
View ArticleOIG “Open Letter” Delivers Welcome News to Health Care Providers
The Office of the Inspector General’s (“OIG’s”) April 15, 2008 Open Letter to Providers (the “Open Letter”) guarantees further benefits to health care providers that choose to disclose and cooperate...
View ArticleTwo New FTC Hospital Merger Enforcement Actions: The FTC Seeks to Block...
During the last several weeks, the Federal Trade Commission ("Commission" or "FTC") has taken two significant antitrust enforcement actions affecting hospitals: (1) The initiation of a merger challenge...
View ArticleCMS Issues 2009 Proposed Physician Fee Schedule Rule: Proposed Changes Would...
On June 30, 2008, the Centers for Medicare & Medicaid Services ("CMS") released the Proposed Physician Fee Schedule ("PPFS") rule for Fiscal Year 2009. As in previous years, the 2009 PPFS includes...
View ArticleHHS OIG Identifies Potential Violation of Anti-Kickback Laws In Proposed...
On August 26, 2008, the Office of Inspector General of the Department of Health and Human Services ("OIG") issued an Advisory Opinion [click to download PDF] to a physician group practice, finding...
View ArticleGetting in Compliance with the FTC Red Flags Rule as May 1st Enforcement Date...
In November 2007, the Federal Trade Commission (the "FTC") released a final rule that requires certain organizations to implement an identity theft prevention program.1 This rule is known as the Red...
View ArticleFTC Extends Enforcement Date of Red Flags Rule to August 1
On April 30th, in a surprising move, the Federal Trade Commission (the "FTC") extended its deferral of enforcement of the Red Flags Rule until August 1, 2009. This marks the second extension by the...
View ArticleFTC Extends Enforcement Date of Red Flags Rule
The Federal Trade Commission (the "FTC") announced that it has postponed enforcement of the Red Flags Rule1 until November 1, 2009.
View ArticleReporting and Repayment of Medicare and Medicaid Overpayments Must Be Made by...
President Obama signed the Patient Protection and Affordable Care Act ("PPACA") on March 23, 2010. Thus, the clock started running on one of the most urgent requirements imposed by that Act -- that...
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