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Health Law Alert
2011: Issue 1 – Focus on Fraud and Abuse
First Settlement Under the Voluntary Self-Referral Disclosure Protocol
By: Julie E. Kass and Joshua J. Freemire
The first Stark settlement since the publication of the CMS Voluntary Self-Referral Disclosure Protocol (SRDP) was announced on February 10, 2011. Saints Medical Center in Lowell, Massachusetts settled with CMS for alleged violations relating to issues with night coverage, medical directorships, and stipends. CMS settled the issues for $579,000, and while CMS won’t reveal the initial overpayment calculation amount, CMS has reported the settlement to be substantially less. A statement released by the hospital as well as local media reports indicate that the hospital’s Stark violations could have triggered a potential repayment amount between $785,000 and $14.5 million.
Click to continue...Valuing Non-Competes: The Bradford Decision
By: S. Craig Holden and Kristin Cilento Carter
In an opinion substantively addressing the Stark law and Anti-Kickback statute, a federal court issued summary judgment against a hospital, a physician practice and its physician owners finding that an equipment subleasing arrangement, and related non-compete agreement, improperly assigned value to the volume of “anticipated referrals” in violation of the Stark law. In United States ex rel. Singh v. Bradford Regional Medical Center, Civ. No. 04-186, 2010 U.S. LEXIS 119355 (W.D. Pa. Nov. 10, 2010), the United States District Court for the Western District of Pennsylvania was asked to evaluate claims brought against Bradford Regional Medical Center (BRMC), V&S Medical Associates, LLC (V&S) and its physician owners, Drs. Vaccaro and Saleh (the Physicians), pursuant to a qui tam action alleging that the defendants submitted, or caused to be submitted, false claims to the Medicare program arising out of referrals from Drs. Vaccaro and Saleh to BRMC. At the heart of the dispute was whether the payments under the sublease arrangement, which included substantial amounts attributable to a non-compete agreement, reflected fair market value. The relators alleged that a sublease agreement for a nuclear camera between BRMC and V&S was intended to gain patient referrals for BRMC in violation of the Stark law and Anti-Kickback statute. The government did not intervene in the action.
Click to continue...New Long-Term Care Facility Closure Notice Requirements Go Into Effect March 23rd
CMS published an interim final rule in the Federal Register on February 18, 2011, amending the long-term care facility closure notice requirements. Long-term care facilities affected by the new rule include skilled nursing facilities (SNF) in the Medicare program and nursing facilities (NF) in the Medicaid program. The Interim Rule, which implements section 6113 of the Affordable Care Act, becomes effective on March 23, 2011. However, CMS will accept comments on the Interim Rule through April 19, 2011. 76 Fed. Reg. 9503 (Feb. 18, 2011).
Click to continue...Incentive Payments Available for Geriatric Medicine Services
By: Donna J. Senft
Geriatric medicine is among the delineated services in which the rendering physician or non-physician practitioner (NPP) is eligible to seek up to a 10 percent incentive bonus from Medicare, paid on a quarterly basis, for service provided from January 1, 2011 through January 1, 2016. “Incentive Payments for Primary Care Services” were added to the Medicare law through Section 5501(a)(2)(A) of the health care reform legislation, the Patient Protection Affordable Care Act or PPACA, to encourage a shift from specialist to primary care physician (and non-physician practitioners or NPPs including nurse practitioners, certain clinical nurse specialists, and physician assistants) services. Primary care services that qualify for the incentive payment calculation are services billed under the following codes.
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