OIG Says Waiver of Laboratory Fees Could Violate Anti-Kickback Statute

In OIG Advisory Opinion 15-04, the requestor, a multi-regional medical laboratory proposed to enter into agreements with physician practices which would allow the requestor to provide all laboratory services for the physician’s patients. The requestor indicated that physicians desired such a relationship because it would provide for better communication and consistency (e.g. consistent reference ranges and interfaces). The current barrier to such a relationship is the requirement by certain “Exclusive Plans” that labwork be sent only to certain designated laboratories… Read More >

CMS Announces April 2015 Release of Ophthalmology Comparative Billing Report; Upcoming Webinar for Modifier 25: Nurse Practitioner Comparative Billing Report

CMS recently announced that it will issue a Comparative Billing Report (CBR) focused on ophthalmology providers in April 2015. Pursuant to the March 19, 2015 MLN Connects Provider News, the CBRs will be produced by CMS contractor eGlobalTech, and will “contain data driven tables and graphs with an explanation of the findings that compare these providers’ billing and payment patterns to those of their peers” both across their state and nationally. The CMS announcement does not indicate which ophthalmology services… Read More >

Senate Bill Seeks to End Federal Prohibition on Medical Marijuana

The Washington Post recently reported on a bill that was introduced in the Senate to end the federal prohibition on medical marijuana.  While the bill would not legalize medical marijuana in all 50 states, it would prevent the federal government from prosecuting physicians, patients or caregivers in those states.  According to Senator Rand Paul’s website the purpose of the bill is to allow the use of medical marijuana in states where it is legal without the fear of federal prosecution…. Read More >

Physician Certification of Home Health Patients For Remuneration Found to be “Referral” and Violation of Anti-Kickback Statute

On February 10, 2015, in the case of United States v. Patel, the Seventh Circuit Court of Appeals affirmed the judgment of the District Court which found Dr. Kamal Patel, an internal medicine specialist, guilty of violating the Anti-Kickback Statute.  The case resulted from a federal investigation which revealed that Dr. Patel had received payments from Grand Home Health Care (“Grand”) for certifying and recertifying home care patients’ plans of care. Dr. Patel’s argument on appeal was that the certification… Read More >