Court Strikes Down Per-Click Restrictions, or Does It?
One of the government's tools for combating fraud and abuse in the healthcare industry is the Stark Law, also known as the self-referral law. In its continual efforts to protect individuals from healthcare fraud, the Centers for Medicare and Medicaid Services has periodically sought to broaden the law and further define the various types of fraud that may occur in the healthcare industry. Recently, the per-click fee restriction included in Stark IV has come under fire in the D.C. Circuit for exceeding the statutory authority of the U.S. Department of Health and Human Services. To understand the court's decision and its implications, it is important to understand both the history of the Stark Law and the history of the case itself. (Read more...)

Fraud Alert Puts Added Pressure on Physicians
On June 9, 2015, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a fraud alert entitled, "Physician Compensation Arrangements May Result in Significant Liability." This alert warns physicians of potential individual liability (in addition to healthcare entity liability) if their medical directorship agreements do not reflect fair market value remuneration for bona fide services provided.The alert emphasized the penalties from the federal Anti-Kickback Statute or Civil Monetary Penalties law under which physicians may be liable if they do not perform the actual duties listed in their medical directorship agreements. (Read more...)

Proposed Medicare Physician Fee Schedule Changes for 2016
The Medicare Physician Fee Schedule (MPFS) is the payment system that sets payments for physicians and other practitioners who treat Medicare beneficiaries. On July 8, 2015, the Centers for Medicare and Medicaid Services released its proposed Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for Calendar Year 2016 rule, with a final rule expected by November 1, 2015. This update includes many notable changes, including some Stark Law alterations, proposed payment provisions for biosimilar products, the separation of payable codes for advanced care planning, and revisions to the Physician Quality Reporting System (PQRS). (Read more...)

SCOTUS Finds Obamacare Insurance Subsidies Legal
On June 25, 2015, the Supreme Court of the United States (SCOTUS) announced its decision in David King, et al. v. Sylvia Burwell, Secretary of Health and Human Services, et al., to uphold the legality of health insurance subsidies for individuals participating in federally-run insurance exchanges. In a six to three landmark decision, with the majority opinion written by Chief Justice John Roberts, the Court upheld the federal government's interpretation of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, allowing the Internal Revenue Service to issue tax credits, or subsidies, to participants who purchase insurance on federally-funded and run exchanges. The first installment in this two-part series describes the Court's decision and reasoning. The second installment of the series will discuss the impact this decision will have on consumers, insurance markets, and more. (Read more...)