Main Page

CMS RECOVERY AUDIT DEMONSTRATION PROJECT UNDERWAY IN NEW YORK

Pursuant to recently enacted legislation, the Center for Medicare and Medicaid Services ("CMS") has contracted with Connolly Consulting Recovery Audit Specialists ("CCRAS"), a Georgia entity. CCRAS will conduct post payment reviews of physician billing for the purpose of identifying incorrectly coded submissions, overpayments, payments for services deemed not medically necessary, payments for non-covered services and payments for duplicative services. In an unrelated matter, CMS also announced last month that through its own aggressive efforts, "improper" fee-for-service Medicare claims payments were reduced by $9.5 billion, a five percent increase from the previous year.

NEW LEGISLATION PROVIDES FOR LESS OVERSIGHT OF PHYSICIAN'S ASSISTANTS WRITING IN-PATIENT NARCOTIC MEDICATION PRESCRIPTIONS

Until recently, Physician's Assistants ("PA's") were permitted to write prescriptions for narcotic medications for hospitalized patients, but state regulations required the supervising physician's countersignature to be placed upon that order within twenty-four hours. Legislation recently enacted now lifts that "twenty-four hour" rule and requires a physician's countersignature only when deemed necessary and appropriate by either the supervising physician or hospital protocol.

U.S. SENATE URGES INVESTIGATION OF RESEARCH ABUSES

Research conducted at some of the country's top universities may soon be the target of a major investigation to be undertaken by the U.S. Department of Health and Human Services, Office of the Inspector General ("OIG"). Congress recently requested that the OIG undertake investigative efforts to determine whether funded research was actually undertaken. Concomitantly, HHS will audit some clinical research grants and search for discrepancies such as false statements, improper accounting, improper charges, and double-billing of the Medicaid program for in-patient fees charges.

PATIENT ADVOCACY ORGANIZATIONS OPPOSE GAINSHARING ARRANGEMENTS

Thirteen patient advocacy organizations recently released a statement opposing gainsharing, based upon the assertion that attempts at such cost-saving practices could, in fact, undermine the quality of patient care. Hospitals enter into gainsharing agreements with physician groups to reward them for implementing broad cost-saving measures. In exchange, the hospital shares any savings realized with those physician groups. While the OIG historically viewed such arrangements with skepticism, it has issued several advisory opinions this year permitting gainsharing in certain circumstances. If any physician is approached to participate in gain sharing concepts, extreme caution should be exercised. Any questions can be directed to Kern Augustine Conroy & Schoppmann, P.C., at 1-800-445-0954.

Top of Page