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Medicaid RACs: Coming Soon to a State Near You

September 15, 2011 | Blog | By Brian Dunphy, Karen Lovitch

Eliminating fraud, waste, and abuse in health care has long been a top government priority, but — as demonstrated by a series of events this week — it likely will garner even more attention as the government seeks to reduce the federal deficit by $1.5 trillion over the next ten years. Providers should closely monitor the developments.
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CMS has announced the publication of a proposed rule that will require HIPAA-covered laboratories to make test results available to patients no later than 180 days after the rule's effective date, which will be 60 days after publication in tomorrow's Federal Register. 
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OIG Advisory Opinion Permits Donation of Telemedicine Items and Services

September 12, 2011 | Blog | By Brian Dunphy, Karen Lovitch

In a recent advisory opinion, the OIG allowed a hospital to share telemedicine resources with another hospital, in the interest of promoting new models of consultation and improving patient care by reducing unnecessary patient transfers.

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Qui Tam "Seal” Windows Shrinking?

August 22, 2011 | Blog | By Daria Niewenhous, Ellyn Sternfield

When qui tam relators/whistleblowers file suit under the civil False Claims Act (FCA), they are “standing in the shoes” of the government to allege that the government has suffered damages due to fraud. 
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This case involved “John Doe,” a 65-year-old registered level-three sex offender. After serving time in jail, Mr. Doe was released to a homeless shelter. After sustaining serious injuries during a mugging, he was hospitalized and later discharged to a nursing home. 
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