June 12, 2009
Five Things You Should Know About the Fraud Enforcement and Recovery Act of 2009
By: Paul S. Weidenfeld* and Kristin Cilento Carter
All health care providers need to be aware of how recently enacted changes to the federal False Claims Act (FCA) may affect them, particularly in the areas of refunding overpayments to the government and filing claims with Medicare and Medicaid managed care plans.
Heralded as an enhancement to fraud enforcement in light of the "mortgage fraud, securities and commodities fraud, [and] financial institution fraud," the Fraud Enforcement and Recovery Act of 2009 (FERA) was recently signed by President Obama. This law makes sweeping changes to the FCA that will significantly impact every business and industry that does business with the federal government either directly or indirectly by encouraging the filing of new qui tam lawsuits and making it easier for them to succeed. Among other things, the new law retroactively overrules the key holdings articulated by the Supreme Court in Allison Engine Co. v. United States ex rel. Sanders, 128 S.Ct. 2123 (2008), expands the scope of statutory liability for "reverse" false claims and specifically includes the retention of an overpayment, and broadly redefines "claims" to include any request, from almost any entity, provided only that the funds were "spent or used on the Government's behalf or to advance a Government program or interest."Click to continue...
Global Warning â€“ Medicare Date of Service Rule May Require Separate Line-Item Claims for Pathology Services
By: Robert E. Mazer
Independent clinical laboratories and physicians need to be aware of a recent change in the Medicare Claims Processing Manual regarding the manner in which physician pathology services must be billed. If the professional and technical components are deemed to have been provided on different days, the services cannot be globally billed.Click to continue...
Your Chance to Tell the Government What Documents You Want to See
By: Carel T. Hedlund
Health care providers, among others, have an opportunity to provide recommendations to the government regarding the kinds of government information they believe should be more readily available. The comments must be received by June 19, 2009.
The Office of Science and Technology Policy (OSTP), a component of the Executive Office of the President, published a notice in the May 21, 2009 Federal Register seeking public participation in the development of recommendations for federal agencies to further the Administration's goals of transparency, participation and collaboration. One of the issues OSTP is specifically seeking comments on is "what government information should be more readily available on-line or more easily searched?"Click to continue...
Tips from the RAC Cave: "Outpatient Observation vs. Inpatient Admission"
By: Paul W. Kim and Mark A. Stanley *
(RAC Man and QIC Boy Wonder
The Recovery Audit Contractors (RACs) are poised to begin their audits this month. This is the first in a series of articles providing tips related to the RAC audits.
No doubt the RACs will target one-day stays. This issue has been plaguing the hospital industry for decades, but it's never too late to be compliant. If real estate is about location, location, location, the key to short-day stays is education, education, education. To ensure reimbursement, the admitting physician must sign, date, and both explain and document the reasons for the admission. As a constant reminder, attach notecard instructions onto each patient chart. Also, train the staff to review the orders and follow up with the admitting physician before the patient is discharged if additional information is needed, especially for weekend admissions and discharges when staff levels may be low.Click to continue...
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