Recently, the Office of Inspector General (the “OIG”), the enforcement arm for the United States Department of Health and Human Services (“HHS”)¹ , released its Fiscal Year 2015 Work Plan. Therein, the OIG “summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.” Each year, the OIG publishes its Work Plan to categorize those areas of focus due to “limitations in the money appropriated to OIG.” The full Work Plan can be found online at: http://oig.hhs.gov/reports-and-publications/archives/workplan/2015/FY15-Work-Plan.pdf. In 2015, the OIG will focus primarily on the billing, […]

By  Richard Haskin, Esq. The Centers for Medicare & Medicaid Services (CMS) released the 2015 final payment rule for ASCs and hospital outpatient departments (HOPDs) on Friday. The final rule can be found here: http://associationdatabase.com/aws/CASA/asset_manager/get_file/88319/medicare_2015_final_rule.pdf. ASC payment rates will increase by 1.4 percent in 2015. This increase is based on a projected rate of inflation of 1.9 percent minus a 0.5 percentage point productivity adjustment required by the Affordable Care Act. This payment update is higher than the 1.2 percent update in the proposed rule, which was based on an inflation rate of 1.7 percent minus a 0.5 percentage point productivity […]

An interesting question evolved several months ago upon creation of the Federal and State run insurance exchanges. Would payments stemming from private insurance companies participating in the public exchanges and accepting public subsidies now become subject to the Federal Anti-Kickback law, prohibiting the remuneration of consideration in exchange for services, referrals and the like? Providers felt sheltered from the Anti-Kickback law as long as the payment came from either a cash or private payor because the Federal law only extended to payments from Federal health programs. However, this assumption was now somewhat in flux with the creation of the public […]

Last week, WellPoint, one of the nation’s largest insurers, settled a HIPAA violation case brought by the Department of Health and Human Services. In a self-reported violation, WellPoint was found to have exposed the personal information of over 612,000 individuals in what WellPoint termed a “lapse in its online security during a routine upgrade of its system.” The “lapse” occurred during a routine online upgrade of WellPoint’s tracking system. HHS said, in a statement, “This case sends an important message to HIPAA covered entities to take caution when implementing changes to their information systems, especially when those changes involve updates […]

The Centers for Medicare and Medicaid Services (“CMS”) just released the new quality reporting codes, categorized as “G-Codes.” All ASCs are required to include these codes in all Medicare claim forms starting on October 1, 2012. The codes denote whether the patient suffered a burn, fall, other wrong including a wrong site, side, patient, procedure or implant event. Other items are included as well. Failure to include the G-Code in claim form will subject an ASC to reduction in Medicare reimbursements. More information and an explanation of the quality reporting codes from CMS can be found on the CMS website, […]