The United States spends about $2.6 trillion annually on health care (17.5 percent of GDP) and with the reform initiatives under the Affordable Care Act (ACA), the number of Americans covered and the amount spent will grow dramatically, potentially leading to even...
Provisions included by Congress Congress included a provision in the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) which barred self-referrals for clinical laboratory services under the Medicare program, effective January 1, 1992. This provision is known as...
Health Insurance Portability and Accountability Act Protected health information or PHI The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule provides Federal privacy protections for individually identifiable health information, called...
Understanding Litigation Litigation involves a series of steps that may lead to a court trial An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute. When a person begins a...
The final rule under HIPAA, released this past January, makes some sweeping changes that will greatly enhance a patient’s privacy rights. Now, a “business associate” also includes a subcontractor that creates, receives, maintains, or transmits protected health...
According to MEDPAC (The Medicare Payment Advisory Commission, an independent congressional agency), hospitals served their Medicare patients at a 5.8% loss in 2011, down from a 4.5% loss in 2010. This was mainly because of the reduction in 2011 payment rates for...
The U.S. DHHS Office of Inspector General Has Issued a Fraud Alert for PODS The Office of Inspector General (OIG) for HHS has issued a Special Fraud Alert regarding Physician-Owned Distributorships (PODs) that sell surgical implants. The POD does not manufacture the...
While searches of the National Practitioner Data Bank (NPDB), the Healthcare Integrity and Protection Databank (HIPDB), System for Award Management (SAM) and State databases can and should be used in addition to HHS’s Exclusion database, they are...
In United States v. Houser and Houser, a 2011 federal criminal court case from Northern Georgia, the United States levied criminal False claim indictments against the Housers for billing for nursing home services that the government claimed were so “deficient” that to...
When one “elects” to have the statutory Patient by Patient Proportional method used in determining the CAP for payment by Medicare for hospice services in a cost reporting year, that election is permanent and the hospice CAP will be calculated by that method for all...
