Mutual Matters

DOJ Announces Two Large False Claims Act Settlements

Posted by Scott R. Grubman, Esq. on Aug 30, 2018 12:03:00 PM

Earlier this month, the Department of Justice (DOJ) announced two large settlements under the False Claims Act (FCA) against hospital systems:

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Topics: Billing and Reimbursement

CMS Proposes Potential Changes to Documentation Requirements

Posted by Scott R. Grubman, Esq. on Aug 23, 2018 11:57:40 AM

On July 27, 2018, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule containing numerous proposed changes to the Medicare physician fee schedule and other Medicare policies. The proposed rule is intended to update Medicare’s payment systems to better reflect the relative value of services. 

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Topics: Billing and Reimbursement, Patient Care and Interaction

New Budget Deal Includes Significant Healthcare Provisions

Posted by Emma Cecil, JD on Mar 1, 2018 12:45:00 PM

On February 9, 2018, Congress passed and the President signed into law the Bipartisan Budget Act of 2018 (BBA), a comprehensive piece of legislation that provides for a two-year budget agreement and funds the federal government through March 23, 2018. The BBA’s sweeping measures address federal spending for the military, domestic programs, and disaster relief, and contain several provisions impacting federal healthcare programs. Among other things, the BBA:

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Topics: Billing and Reimbursement

Medicare Update - Appropriate Use Criteria 

Posted by Hoyt Torras, MPA, MHA on Jan 19, 2018 12:05:00 PM

This summary is based primarily on the Medicare Physician Fee Schedule CY2018, Final Rule – Published in the Federal Register November 15, 2017.

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Topics: Billing and Reimbursement

Billing Under Another Provider's Number Can Land Physicians in Hot Water

Posted by Emma Cecil, JD on Nov 7, 2017 11:29:00 AM

An Oklahoma physician agreed on August 28, 2017 to pay the government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest, to use his national provider identification (NPI) numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he separated from the company and deactivated his NPIs associated with the company, he reactivated those NPIs so that the company could use them to bill Medicare for services he neither performed nor supervised.

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Topics: Billing and Reimbursement

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As one of the leading mutual providers of Medical Professional Liability insurance, we're here to help all healthcare professionals with the challenges they face on a daily basis. The topics we cover include: 

  • Healthcare legislation updates
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