January 2010 Archives

January 26, 2010

U.S District Court Dismisses Lawsuit Regarding Physician Payment Cuts to Medicare Reimbursements

The U.S. District Court for the Southern District of Florida dismissed a lawsuit filed by the American College of Cardiology (ACC) against the Department of Health and Human Services (DHHS). The suit was based on the DHHS's cuts to Medicare reimbursements for cardiology services. The ACC requested the court to block the cuts and to prevent Medicare from using the Physician Practice Information Survey (PPIS) methodology for calculating payment rates. According to the ACC, PPIS methodology does not provide an accurate picture of physician costs. In its ruling, the court stated that it dismissed the lawsuit because it did not have the authority to review Medicare claims.

This ruling will affect Medicare physicians of all specialties who may face a 21.2% fee cut as a result of the 2010 Physician Fee Schedule. Although the U.S. House of Representatives passed a bill that would prevent this 21.2% physician payment cut in November, the Senate has yet to vote on a permanent solution. For now, the House voted to temporarily suspend the cut for two months.

For more information, visit www.wachler.com or contact one of our attorneys at 248-544-0888.

January 23, 2010

OIG Fraud Alert to DME Suppliers on Telemarketing Prohibition

On January 13, the Department of Health and Human Services' Office of Inspector General (OIG) issued a special fraud alert to remind durable medical equipment (DME) suppliers that unsolicited telephone calls to Medicare beneficiaries are prohibited by federal law. The fraud alert referred specifically to instances in which independent marketing firms make unsolicited contact with Medicare beneficiaries to market the DME supplier.

The Social Security Act prohibits such unsolicited contact by a DME supplier, except in three specific situations:

(1) when the beneficiary has given express written permission to the supplier to contact him or her by phone;

(2) the contact is about a covered item that the supplier already has furnished to the beneficiary; or

(3) the supplier has furnished at least one covered item to the beneficiary during the preceding 15 months.

The Social Security Act also states that payments are prohibited to a supplier that knowingly submits a claim produced by unsolicited contact with a Medicare beneficiary. Any such payments are considered false and could subject the violator to criminal, civil and administrative penalties.

For more information, visit http://www.wachler.com/ or contact one of our attorneys at 248-544-0888.