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Showing 27 posts by Gary J. McRay.

Can a Non-Physician Own and Operate a Medical Facility in Michigan?

An interesting case is winding its way through the Michigan Court of Appeals that involves the question of whether a layperson, as opposed to a licensed physician, can own a for-profit business that provides medical services. Read More ›

Categories: Compliance, Licensing, Providers

OIG Recommends Audits of Meaningful Use Incentive Payments

In order to encourage health providers to use electronic medical records (“EHRs”) in lieu of paper records, Congress passed the Medicare and Medicaid Health Information Technology for Economic and Clinical Health Act (“HITECH Act”) in 2009. Read More ›

Categories: HITECH Act, Medicare/Medicaid

What’s Next After Health Care Bill’s Failure in Congress?

Affordable Care ActDespite controlling the presidency, and both houses of Congress, the Republican’s bid to repeal and replace the Affordable Care Act (ACA) failed. The Republican’s replacement bill - the American Health Care Act (AHCA) - was pulled before proceeding to a vote in the U.S. House of Representatives, as it apparently lacked the votes to pass. Here’s what businesses need to know now that this (first?) attempt to repeal the ACA failed. Read More ›

Categories: Compliance, Insurance

DOJ Starts Cracking Down on Individual Health Care Executives for False Claims Act and Stark Law Violations Committed by Their Companies

Healthcare executives and physicians take note: The Department of Justice is now cracking down on individuals, and not just companies, for False Claims Act, Stark law, and anti-kickback statute violations. Read More ›

Categories: Hospitals, Medicare/Medicaid, News & Events, Physicians

CMS Final Rule on Reporting and Returning of Overpayments Has Potentially Only an Eight-Month Safe Harbor

The Final Rule on Reporting and Returning of Overpayments (“Final Rule”), which became effective on March 14, 2016, requires Medicare providers to report and return Medicare overpayments by the later of (i) 60 days after the date on which the overpayment was identified, or (ii) the date on which any corresponding cost report was due. This 60-day deadline for returning overpayments is suspended when any of the following occurs: Read More ›

Categories: Billing/Payment, Compliance, Medicare/Medicaid

Quality versus Quantity Transformation in Healthcare Picks Up Pace as CMS Issues New Rules

cms issues new rulesThe march to transform Medicare from a quantity-based to a value-based system continues unabated - and the pace is quickening. Over the past several months, the Centers for Medicare & Medicaid Services (“CMS”) issued several final rules to update certain Medicare reimbursement rates and quality reporting requirements that impact vast numbers of healthcare providers. Read More ›

Categories: Billing/Payment, Medicare/Medicaid, Providers

CARE Act Legislation Signed Into Law By Governor Snyder and Set to Take Effect July 12th

care act legislationThe Michigan CARE Act, recently signed into law by Governor Snyder, is set to take effect on July 12, 2016. Michigan becomes the 29th state to enact the CARE Act, which is intended to support and equip family caregivers with information and training when loved ones go into the hospital and as they transition home. A copy of Public Act No. 85 is available here. Read More ›

Categories: Compliance, Hospitals, News & Events

Is Losing Money by Employing Physicians a Stark Violation?

losing money by employing physiciansModern Health Care has reported that hospitals often lose approximately $176,000 a year per each employed physician.

While this initially seems like a surprising statistic, it is understandable that hospitals lose money when they employ physicians. Physicians in private practice often pay their staff less than comparable hospital employees. When a hospital buys a physician’s practice, the benefit costs typically increase if the staff receives the hospital’s fringe benefit package. Moreover, hospital overhead is typically higher than a private physician practice with regard to HR costs and other support services.

Many systems claim that the only way to manage the health of a given population (which is what ACO and other similar payment structures are requiring) is to be fully integrated with employed physicians, so covering the losses incurred by employing physicians is the necessary cost of preparing for the new paradigm. The ugly, and legally problematic, truth is that most health systems look beyond the income generated by physicians for treating patients but also at income from physician ancillary referrals to justify the economic losses caused by acquiring physician practices. This raises concerns under the Stark law. Read More ›

Categories: Billing/Payment, Compliance, Hospitals, Medicare/Medicaid, Physicians

Department of Justice Enters Into Record-Breaking Stark Law Settlement

The U.S. Department of Justice (DOJ), and a handful of states, recently reached a settlement agreement with Adventist Health System (Adventist), resolving Stark Law issues, as well as allegations in two separate qui tam actions that included false claims. Generally speaking, the Stark Law limits physician referrals of designated health services or “DHS” for Medicare and Medicaid patients in instances where the physician - or an immediate family member of the physician - has a financial relationship with the DHS entity.  Read More ›

Categories: Billing/Payment, Medicare/Medicaid, News & Events, Physicians

Quality vs. Quantity: Accountable Care Organization Results Keep Coming, as Does Some Criticism

Quality vs. Quantity: Accountable Care Organization Results Keep Coming, as Does Some CriticismOne of the primary ways that the Affordable Care Act seeks to reduce health care costs is through the formation of Accountable Care Organizations (ACO). ACOs are still a relatively new concept in the healthcare world, as they emerged in 2011 as a result of an initiative by the Centers for Medicare & Medicaid Services (CMS).

ACOs are generally groups of doctors, hospitals, and other health care providers, who voluntarily join forces for the purpose of providing coordinated care to Medicare patients (see other Foster Swift articles on ACOs). ACOs were established as a means of coordinating care in order to ensure that patients, especially the chronically ill, receive effective care while avoiding unnecessary duplication of services and preventing medical errors. ACOs that achieve cost saving from providing timely and accurate care that meet quality benchmarks share in Medicare savings. In short, ACOs are intended to encourage quality of care, not quantity of care, and ACOs that deliver care more efficiently are eligible for bonuses. Read More ›

Categories: Accountable Care Organizations, Health Care Reform, Medicare/Medicaid, News & Events, Providers