1. Medicare Announces Conditions for Coverage Exception for Same-Day Scheduling of Surgery — CMS announces an exception to the Conditions of Coverage for the patient notices required in advance of the day of surgery for ASCs. The exception includes first-time patients who are referred to the ASC for same-day surgery if the referring physician indicates that the procedure is medically necessary and that the surgery center is suitable for the patient.
2. HHS’ Inspector General Issues Advisory Opinion on Physician On-Call Coverage — The HHS’ Office of the Inspector General issues an advisory opinion to a hospital stating that its flat-fee payment schedule for physician on-call coverage presented a low risk of fraud and abuse.
3. FTC Grants 3 Month Delay of Enforcement of “Red Flags Rule” for Identity Theft Prevention — The Federal Trade Commission announces that it will delay enforcement of the new “Red Flags Rule” until Aug. 1 to give more time to physicians, ASCs, hospitals and other creditors to develop and implement written identity theft procedures. The FTC also publishes a new Web site and an alert to help explain what types of businesses fall under the rule.
4. DOJ and HHS Announce Interagency Effort to Reduce Healthcare Fraud — U.S. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announces the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), an interagency effort between the Department of Justice and HHS. HEAT will include senior officials from both departments and will focus on combating Medicare fraud.
5. Working Group Urges CMS to Reconsider Its Decision on CTC Colonoscopy — The CTC Working Group urges CMS to reconsider its decision not to cover computed tomography colonoscopy, or virtual colonoscopy, procedures for its patients, saying that the decision “eliminates patient choice and reinforces different standards of care between Medicare beneficiaries and those with private health insurance.”
6. Massachusetts Considers Drastic Changes to Physician Reimbursement — A Massachusetts state commission recommends that healthcare insurers pay physicians and hospitals a set payment for a patient’s coverage over the entire year as opposed to the state’s current fee-for-service program.
7. Three Texas Residents Convicted of $36M Medicare Fraud — Rhonda Fleming, the owner of medical supply companies and a Medicare billing firm, and two of her co-workers were convicted by a Houston federal jury for their roles in a $36 million Medicare fraud scheme.
8. WellCare Pays $10M to Settle SEC Probe — Tampa-based WellCare Health Plans agrees to pay $10 million and $1 for disgorgement to resolve an informal probe of its accounting practices by the Securities and Exchange Commission. The company previously settled with the State of Florida after allegations of Medicaid fraud.
9. Pres. Obama’s Plan to Reduce Healthcare Spending Raises Antitrust Concerns — President Obama’s plan to reduce healthcare spending by $2 trillion over the next 10 years creates legal concerns regarding antitrust laws for companies that collaborate to hold down pricing.
10. New Bill Designed to Ease Nurse Shortage Over the Next Three Years — HR 2536, introduced by Rep. Robert D. Wexler (D-Fla.), will increase the number of work visas set aside for foreign-educated nurses and provide support for nursing programs in order to increase the number of nurses in the United States.
