New OIG Fraud Alert Focuses on Compensation of Medical Directors

The United States Department of Health and Human Services Office of Inspector General (“OIG”) issued a short Fraud Alert last week focusing on the anti-kickback implications of certain compensation paid to medical directors. OIG noted that it had recently settled with a dozen physicians who had entered into medical director positions of various health care […]

HHS OIG 2010 Medicare Audit: $6.7 Billion Misspent for Evaluation and Management Services

The United States Department of Health and Human Services Office of the Inspector General (“OIG”) has completed its audit of 2010 Medicare payments for Evaluation and Management (“E/M”) services. The audit report, available at  https://oig.hhs.gov/oei/reports/oei-04-10-00181.asp, states that the Medicare program overpaid providers $6.7 billion for E/M services that were incorrectly coded or lacked documentation in […]

OIG: PODs “Inherently Suspect”

On Tuesday, the federal Office of the Inspector General (“OIG”) issued a Special Fraud Alert (“Fraud Alert”) detailing the OIG’s concerns with Physician-Owned Entities.  Specifically, the alert dealt with physician-owned distributorships, or PODs.  PODs are typically entities that make money by selling or arranging for the sale of implantable medical devices. The United States Senate […]

HIPAA: Conversion to Version 5010

As of January 1, 2012, all healthcare providers were required to transition from version 4010/4010A to version 5010 standards for submitting electronic transactions, and the failure to comply may result in claim denials or a government investigation. CMS has repeatedly postponed enforcement, but it appears the agency will begin to enforce civil monetary penalties against […]

Providers and Insurers Look to Urgent Care Facilities to Lower Costs

The expected cuts to Medicare via the Patient Protection and Affordable Care Act (“PPACA”) have many health care providers and insurers assiduously reviewing various efficiency and spending measures.  The latest edition of the Albany Business Review  highlights one emerging trend in these efforts: steering individuals with minor ailments away from hospital emergency rooms and into “urgent […]

HIPAA-Based Criminal Indictment for Communicating with Patient’s Employer

A Virginia physician has become the first person criminally indicted under the Health Insurance Portability and Accountability Act (HIPAA) for communicating with a former patient’s employer. According to the United States Attorney for the Eastern District of Virginia, Dr. Richard Kaye, the former Medical Director of the Psychiatric Care Center at Sentara Obici Hospital in Suffolk, Virginia, […]

American Medical Association Introduces New Policy on the Use of Social Media

The American Medical Association (AMA) recently approved a policy for physician’s use of social media.  This policy is available here.  The AMA noted that while “social networking and other similar Internet opportunities . . . enable individual physicians to have a professional presence online” they also “create new challenges to the patient-physician relationship.” In an […]