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Automatic Denial Authority for “Related claims”

CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” Effective March 6, 2014, CMS amended the Medicare Program Integrity Manual giving MACs, RACs, CERT contractors, and ZPICs discretion to automatically …..

March 6th, 2014|Categories: Health Law|Tags: , |

Sixth Circuit Dismisses Racial Discrimination Claim by Surgeon Following Suspension of Privileges

For Brintley to prevail on her state-law racial discrimination claim, the appeals court observed that the lack of any direct evidence that St. Mary’s discriminated against her on the basis of her race required Brintley …..

February 13th, 2014|Categories: Health Law|Tags: |

Physician Owned Hospitals Must File Annual Report by December 1, 2013 to Comply with Stark II

The Centers for Medicare & Medicaid Services (“CMS”) defines hospitals with physician owners or investors as Physician Owned Hospitals. Physician Owned Hospitals utilizing the Stark II whole hospital and rural provider exceptions must now file …..

November 26th, 2013|Categories: Fraud & Abuse Compliance, Health Law, Stark II|Tags: |

The Affordable Care Act and Closing the Prescription Benefit Coverage Gap

(“Doughnut Hole”) Medicare Part D Coverage Gap Under the Medicare Part D Prescription Drug Benefit, many Medicare beneficiaries have annually encountered a large gap in their prescription drug coverage that is commonly referred to as …..

October 8th, 2013|Categories: Health Law, Medicare & Medicaid Enrollment, Provider Operations|Tags: |

Hospital-Physician Employment Agreements: Sorting through the Aftermath of the Tuomey Decision

It is critically important for hospitals to be especially vigilant about complying with Federal and state fraud and abuse statutes in relation to the Hospital’s financial arrangements with physicians. A jury in a Federal trial …..

August 30th, 2013|Categories: Health Law, LLC Operating Agreements, Provider Operations|Tags: |

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