The U.S. Supreme Court has agreed to review the scope of the Medicare Secondary Payer Act (MSPA) as it relates to the treatment of patients with end-stage renal disease (ESRD). The case to be heard by the high court, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita, Inc.[1], originated from a suit
2022 Medicare PFS Extends Telehealth Services Expansion
The 2022 Medicare Physician Fee Schedule Final Rule released on November 2 by the Centers for Medicare & Medicaid Services (CMS) added certain services to the Medicare telehealth services list through December 31, 2023. Last year, we wrote about temporary “Category 3” services that were added to the Medicare services list for the duration of
OIG Approves Hospital “Warranty” on Joint Replacement Procedures
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion on an arrangement that would allow a hospital to offer free items and services to patients who experienced certain complications after undergoing joint replacement procedures at the hospital. The arrangement only applied to a specific list
OIG Issues Favorable Advisory Opinion on Arrangement between Medigap Plan and Hospital Network
On August 16, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a favorable Advisory Opinion regarding an arrangement between a Medicare Supplemental Health Insurance (“Medigap”) plan and a preferred hospital organization (PHO). The arrangement in question incentivized Medigap policyholders to seek inpatient care from hospitals that participated in the
Hospitals Violate Price Transparency Rule; CMS Proposes Increased Penalties
A new federal hospital price transparency rule that took effect on January 1, 2021, requires hospitals to post all prices for services online in an easily accessible format. However, a report recently released by PatientRightsAdvocate.org found that 94.4% of hospitals were not in compliance with the rule, because one or more price transparency requirements were
NPDB Reporting Protected by Law in Some Cases, Gray Areas Problematic
An article in the July issue of Hospital Peer Review, “NPDB Reporting Protected by Law in Some Cases, Gray Areas Problematic,” discussed hospitals’ obligations to report doctors to the National Practitioner Data Bank (NPDB) and their protection against liability for doing so. Rivkin Radler’s Chris Kutner was quoted extensively in the article.
OIG: Hospitals Need to Improve Oversight of Cybersecurity for Networked Medical Devices
On June 23, the Department of Health and Human Services Office of Inspector General (OIG) posted on its website an Issue Brief entitled “Medicare Lacks Consistent Oversight of Cybersecurity for Networked Medical Devices in Hospitals.” According to the OIG, the Centers for Medicare & Medicaid Services should amend interpretative guidelines or other nonbinding guidelines, or
FDA Issues Medical Device Safety Guidance for MRI Facilities
On May 19, the U.S. Food and Drug Administration (FDA) issued final guidance for assessing the safety and compatibility of medical devices within magnetic resonance imaging facilities. The guidance applies to implanted devices, external devices like insulin pumps and pulse oximeters, and any other devices that may be brought into MRI rooms, but not to
OIG Issues Favorable Advisory Opinion on Hospital/Physician Joint Venture ASC
In a recent advisory opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) concluded that certain investments by a health system, manager and physicians in an ambulatory surgery center (ASC) did not create a substantial risk of fraud and abuse under the federal Anti-Kickback Statute (AKS) even though the
Pandemic response, fraud and abuse top Biden’s enforcement priorities
A March 24 article in Wolters Kluwer’s Health Law Daily, “STRATEGIC PERSPECTIVES: Pandemic response, fraud and abuse top Biden’s enforcement priorities,” quoted healthcare industry experts who predict increased enforcement in the areas of fraud and abuse, False Claims Act (FCA) cases, and pandemic-related waivers. Rivkin Radler’s Robert Hussar was quoted in the