The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a special fraud alert (Alert) in June concerning suspect arrangements between laboratories and physicians that raise Anti-Kickback statute (AKS) concerns.
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The NYS Medicaid recently informed referring and servicing providers that, effective for services provided on and after October 1, 2013, claims will be denied if they include the NPI of non-enrolled ordering, prescribing, referring or attending provider (OPRA). Below we discuss some of the changes. Round 2 competitive bidding program (Program) went into effect as of July 1, 2013 in 91 Metropolitan Statistical Areas (MSAs). At the same time, Medicare began the national mail-order program for diabetic supplies. Below we discuss some of the features of the Program and what this may mean for DMEPOS suppliers and those healthcare providers who refer patients for durable medical equipment and supplies. The Antikickback statute is a law that seeks to regulate the financial relationships between physicians and/or other provider entities where there is a possibility of patient referrals for items or services reimbursable by a Federal health care program. In this, it is much like the Stark Law, about which we wrote in the past. The federal self-referral law, often referred to as the Stark Law, prohibits a physician from referring patients to receive “designated health services” (DHS) payable by Medicare or Medicaid to an entity with which the physician or an immediate family member has a financial relationship. See 42 U.S.C. §1395nn. While referral fees is a common practice for many businesses, it’s a big no-no when it comes to the practice of medicine in New York and physicians may be staring down professional misconduct charges if they cross the line. Many laws and regulations speak to this issue. More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy”. According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group |
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