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Compliance Update


Lessons learned from whistleblower FCA case against cancer treatment company Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Tuesday, 15 March 2016 18:23

Earlier this month, the U.S. Department of Justice announced that 21st Century Oncology and its wholly owned subsidiary, South Florida Radiation Oncology LLC, agreed to settle False Claims Act allegations relating to billing for procedures that were medically unnecessary. Specifically, the Fort Myers, Florida-based company was alleged to have billed for performing the Gamma function - a medical procedure designed to measure the exit dose of radiation from a patient after receiving radiation treatment.
 
The government alleged that the procedure served no medically appropriate purpose; that they were conducted by those who were not trained to interpret and use the results; that in some instances the results were not even reviewed until a week or more after the last day of a patient's treatment; and, in other cases, they billed for the procedure even if the results were not available due to imaging equipment failures.

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Last Updated on Monday, 04 April 2016 11:56
 
Board Revises Florida's Telemedicine Practice Rule for Physicians Print E-mail
Written by Florida Healthcare Law Firm Blog   
Monday, 29 February 2016 00:00

Effective March 7, 2016, the Board of Medicine's revised Telemedicine Rule, Rule 64B8-9.0141, F.A.C., goes into effect. The amended rule reads...

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Adventist Health System to pay $2M for allegedly giving leftover chemo to patients Print E-mail
Written by Ayla Ellison | Becker's Hospital Review   
Monday, 22 February 2016 00:00

Altamonte Springs, FL based Adventist Health System Sunbelt Healthcare has agreed to pay the  federal government $2.09 million to resolve allegations that patients at one of its hospitals were administered leftover portions of single-dose vials of chemotherapy drugs, according to the Department of Justice.

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Last Updated on Tuesday, 23 February 2016 16:42
 
CMS Issues Final Rule Governing the Return of Overpayments within 60 Days Print E-mail
Written by MWE.com   
Thursday, 18 February 2016 00:00

On February 11, 2016, the Center for Medicare and Medicaid Services (CMS) issued the much-anticipated final rule concerning Section 6402(a) of the Affordable Care Act, the so-called "60 Day Rule". This section requires Medicare and Medicaid providers, suppliers and managed care contractors to report and return an overpayment by the later of "60 days after the date upon which the overpayment was identified or the date any corresponding cost report was due, if applicable." CMS delayed adopting the rule to address public comments concerning, among other things, (1) the meaning of "identify" (i.e., what starts the 60-day clock); and (2) the length of the "lookback period." This rule is of critical importance to healthcare providers seeking to avoid liability for reverse false claims under the False Claims Act (FCA).

Under the new regulation, 42 C.F.R. ยง 401.305, the 60-day clock starts when a provider has identified an overpayment, which is defined as "when the person has, or should have through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment. A person should have determined that the person received an overpayment and quantified the amount of the overpayment if the person fails to exercise reasonable diligence and the person in fact received an overpayment." Backing off from the proposed 10-year lookback period, CMS finalized a 6-year lookback period.

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Additional Guidance to the Medicare EHR Incentive Program Hardship Exception Process Print E-mail
Written by HealthFusion   
Thursday, 04 February 2016 00:00

As we mentioned in our blog post, How the Feds Botched Meaningful Use, Part 2, Congress recognized the impact that CMS' delayed rule-making in the final quarter of 2015 had on providers and vendors, and acted in bipartisan fashion. The "Patient Access and Medicare Protection Act" (PAMPA), Pub. L. No. 114-115 was signed into law by President Obama on December 28, 2015, which includes a number of Medicare provisions designed to reduce burdens on clinicians, hospitals and critical access hospitals (CAHs) These provisions are part of an ongoing effort to "smooth things over" and improve the Medicare EHR Incentive Program on the part of CMS.

The law will extend the deadline and streamline the application process for the hardship exception from Meaningful Use penalties by reducing the amount of information that must be submitted to apply for an exception.

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