November 17, 2023 | By Amanda Waesch This past September 2023, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) issued Advisory Opinion 23-06 (AO).1 The Opinion involved a proposed arrangement between an independent pathology laboratory and third-party physician laboratories for the purchase of the technical component of…
September 15, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein If you lie awake at night worrying about whether your coding, auditing, or compliance practices might be based on misinterpretations of federal law, opening up your healthcare employer—or yourself!—to treble damages and penalties under the False Claims Act (FCA), you may…
October 27, 2023 | By Rachel Rose, JD, MBA “Do not go gentle into that good night” is a poem by Dylan Thomas. While this poem is often connected with a dying individual, it is equally apropos to procuring technology which includes generative artificial intelligence (“AI”). As set forth in the American National Standard…
April 9, 2021 | By Amanda Waesch In December 2016, Congress passed the 21st Century Cures Act (often simply called the “Cures Act”). Woven within the Cures Act is Section 4004 titled “Information Blocking.”[1] The purpose of this section is to prohibit any action or practice that interferes with or prevents access to electronic…
A question that I get asked repeatedly, that I haven’t taken the time to address in a long time, came up on a webinar that I was doing for orthopedic executives and coders. What happens when a provider sees a patient and then later finds out that they were a resident of a Skilled Nursing…
March 10, 2023 | By Bryan Meek, Esq., Brennan, Manna, and Diamond OVERVIEW: The Eliminating Kickbacks in Recovery Act (“EKRA”), part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act, was passed in 2018. Since its passing, there has been very limited guidance as to how…
THE RECAP An announcement on Monday, January 30th, by the OMB (Office of Management and Budget), and the White House, stated that they plan to end the COVID-19 national emergency and public health emergency on May 11th. The end of the emergency declarations would signal a new chapter in the Biden administration’s response to the…
October 14, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Why is it that payors often, can’t or won’t comply with their own reimbursement rules or guidelines for processing/adjudicating claims? Some (who are contracted to The Centers for Medicare and Medicaid Services (CMS)) may view this blog in a negative…
Strategic Litigation Services | CEMA Certification | Audit Services Details of the Case From Expert Witness Sean M. Weiss Recently, Sean M. Weiss with NAMAS’ parent company DoctorsManagement testified as an expert witness in a federal court case against four healthcare providers in one of the largest Medicare/Medicaid fraud cases in U.S. history. Read below as Sean recaps…
June 24, 2022 | By Rachel Rose, JD, MBA By now, providers should appreciate that there are legal ways to structure most arrangements. One area that is fraught with peril are physician owned distributorships, which are also referred to as “PODs”. PODs are defined as: “physician-owned entities that derive revenue from selling, or arranging…