Health Law Monitor

CMS Announces Cut in Physician Reimbursement Rates and Changes to Supervision Requirements for Outpatient Services

CMS issued the 2011 Medicare Physician Fee Schedule final rule, which cuts physician reimbursement by 24.9% between November 2010 and January 2011. Additionally, CMS recently released its 2011 Outpatient Prospective Payment System final rule setting forth several changes to physician supervision requirements for hospital outpatient services to take effect on January 1, 2011.

Health Reform Whitepaper: Strengthening the Fraud and Abuse Laws

The fourth and final installment of our health reform series focuses on how the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (referred to together herein as “PPACA”) strengthens the enforcement of health care fraud and abuse laws. Just last month, Department of Health and Human Resources Inspector General Daniel R. Levinson testified on Capitol Hill that PPACA “…will significantly enhance our effectiveness in fighting waste, fraud, and abuse in the Medicare and Medicaid programs.” Levinson added that the perpetrators of health care fraud and abuse range from “street criminals” to “Fortune 500 companies.”

Amendments to Civil False Claims Act Create Additional Hurdles for Healthcare Providers

On May 20, 2009, President Obama enacted the Fraud Enforcement and Recovery Act of 2009 (FERA). This sweeping legislation included comprehensive changes to the civil False Claims Act (FCA), marking the first time in over twenty years that the FCA has been amended.  These changes expand the breadth and scope of the FCA, thereby providing the government with important new tools in its fight against fraud.  These changes have significant implications for health care providers, especially if overpayments have been received under the Medicare and Medicaid programs.