Cleveland Clinic employees who fail to meet certain health goals are facing a 21 percent increase in their insurance premiums. Hospital officials have told employees to join the “Healthy Choice” program or be prepared to pay the cost.
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will deny Medicaid payments to providers delivering services in the treatment of preventable healthcare-acquired illnesses or injuries.
In early March, the Inspector General of the U.S. Department of Health and Human Services (HHS) testified before Congress regarding the efforts of HHS to combat waste, fraud, and abuse in Medicare and Medicaid. Through stepped-up enforcement and audit efforts in fiscal year 2010, the Office of Inspector General (OIG) of HHS recovered more than $3 billion in investigatory recoveries and more than $1 billion in audit receivables. But the Centers for Medicare and Medicaid Services (CMS) estimates that 10.5% of the $34.3 billion in Medicare fee-for-service claims it paid in 2010 did not meet program requirements.
A recent decision by a federal district court in Washington D.C. serves as a warning to executives of healthcare-related corporations to be vigilant against healthcare fraud within their own businesses, or face personal, career-ending consequences.
According to a new study by the Center for Studying Health System Change, physician ownership and leasing of medical equipment in the United States is very common. The study found that in 2008, 25% of the 2,750 physicians in physician-owned practices reported that their practice owned or leased equipment for laboratory services, 23% for X-rays, 29% for non-invasive procedures, and 11% for invasive procedures.
The Department of Justice (DOJ) is making the prosecution of healthcare fraud a priority. This is straight from the mouth of DOJ’s chief of the Health Care Fraud Unit, whose name is Hank Walther.
In a recent interview, Walther revealed that DOJ is committing significant resources to fighting healthcare fraud. Since the creation of the Medicare Fraud Strike Force in 2007, the number of prosecutors working on such fraud cases has increased from six to over twenty.
Two recent high-profile Stark cases involving Tuomey Healthcare Systems in South Carolina and Marion General Hospital in Ohio offer good evidence that legal advice on physician-related transactions is worth the investment. Earlier this year, Tuomey was found guilty by a jury of violating the federal physician self-referral “Stark” law, and may have to repay nearly $45 million in Medicare reimbursement and face potential exclusion from Medicare participation, while Marion General Hospital agreed to a $1.2 million settlement for Stark violations.
Hospitals continue searching for ways to meet ever-increasing demands for improving care in the face of revenue pressures, some of which involve working in a conjunctive manner with the hospital’s medical staff. One such approach that is quickly gaining traction is a process known as clinical integration.
Hospitals and physicians face an ongoing dilemma: How to devise business strategies for bringing the two together in beneficial ways,
Physician ranking systems are being utilized with greater frequency by commercial health insurers. Typically, these systems are designed to provide
If your work involves any legal issues associated with physicians and hospitals, there is a good chance you have heard
The Internal Revenue Service (“IRS”) is rather vigilant in regulating charities and revoking their Federal tax-exempt status if they act
For years, federal and state laws have prohibited hospitals from giving physicians any payments or gifts with the intention of
It is difficult to visit any physician’s office and not notice various items splashed with the names of prescription drugs.