Physicians enrolled in Medicare are all-to-familiar with the constraints of the Stark Law which prohibits physicians from making referrals for designated health services (“DHS”) payable by Medicare when the physician (or immediate family member) has a financial relationship with the entity performing the DHS.  On March 30, 2020, CMS announced a number of Stark Law

CMS has expanded Medicare telehealth benefits on a temporary and emergency basis pursuant to the Coronavirus Preparedness and Response Supplemental Appropriations Act.  Starting March 6, 2020, Medicare will pay for office, hospital, and other visits furnished via telehealth provided by doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers.  The HHS Office of Inspector

On September 10, 2019, the Centers for Medicare and Medicaid Services (“CMS”) published a Final Rule in the Federal Register which will require Medicare, Medicaid, and Children’s Health Insurance Program (“CHIP”) providers and suppliers to disclose current and previous affiliations with other providers and suppliers who CMS identifies as posing an undue risk of fraud,

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CMS issued an Alert on November 15, 2016, concerning 2017 Recovery Thresholds.  On December 12, 2016, it issued another Alert regarding 2017 Reporting Thresholds.  CMS also updated its NGHP User Guide on January 3, 2017.

The effect of the Alerts:

Reporting Threshold:  $750.00 for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation payments.

Historically, the Benefits Coordination and Recovery Center (“BCRC”) arm of the Centers for Medicare & Medicaid Services (“CMS”) collected Medicare’s conditional payments.  While the BCRC continues to address Medicare’s reimbursement rights with Medicare beneficiaries, in late 2015 the CMS’s Commercial Repayment Center (“CRC”) took over responsibility for seeking reimbursement directly from Applicable Plans.  Applicable Plans

The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services (HHS) announced on June 18, 2015, that the efforts of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the DOJ and HHS to prevent and deter Medicare fraud, resulted in a nationwide Medicare Fraud Strike

The OIG issued Advisory Opinion 15-3 to address an arrangement proposed by a licensed offeror of Medicare Supplemental Health Insurance (“Medigap”) policies (the “Requestor”), in which the Requestor would indirectly contract with a preferred hospital organization (“PPO”) having contracts with a national network of hospitals (the “Network Hospitals”) for discounts on otherwise-applicable Medicare inpatient deductibles

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The latest OIG Advisory Opinion, issued February 9, 2015, addresses the issue of sharing federal health care program payments with an excluded practitioner.   While federal statutes prohibit payment by any federal health care program, including Medicare or Medicaid, for items or services furnished by an excluded person or furnished at the medical direction or on