HHS Delays 2010 HHS Federal Poverty Rate Update To March 1, 2010

Rates Often Impact Federal Low Income & Other Charity Programs

By Cynthia Marcotte Stamer

Health care, educational and other charity care and other organizations participating in federal programs that determine eligibility based on the Federal Poverty Rate may continue to rely on 2009 Federal Poverty Rates until at least March 1, 2010.  However these federal program participants and other organizations and programs that otherwise rely on Federal Poverty Rates for purposes of making eligibility, sliding scale fees or other determinations will want to watch for the updated guidelines and make appropriate updates as necessary when the new guidelines are released over the next few months.

The U.S. Department of Health & Human Services (HHS) usually issues annual updates to the Federal Poverty Rates in January.  However, HHS announced January 22, 2010 that its annual update of Federal Poverty Rates for 2010 will be delayed until at least March 1, 2010.   As a result of this announcement, 2009 Federal Poverty Rates will remain in effect for the time being until at least March 1, 2010.

Health care organizations and a wide range of other organizations and programs use the Federal Poverty Guidelines to decide program eligibility or fees.  Many federal programs use the federal poverty guidelines as one criterion for federal program eligibility.  For example, the Medicaid and State Children’s Health Insurance (SCHIP) programs determine eligibility largely on the basis of whether the applicant’s income is below the federal poverty guidelines.  Other programs determine financial eligibility based on a percentage or multiplier of the federal poverty guidelines (for example, 125 percent of federal poverty guidelines).  In addition, the federal poverty guidelines are used in the immigration context, such as Form I-864 Affidavit of Support.

Under the 2009 Federal Poverty Guidelines continued in force by the HHS announcement, the applicable income amounts under the 2009 Federal Poverty Guideline in the 48 contiguous states and Washington, D.C. are as follows:

2009 Poverty Guidelines for the 48 Contiguous States and the District of Colombia*
Number of Family Members	Poverty Guideline Income
1	$10,830
2	$14,570
3	$18,310
4	$22,050
5	$25,790
6	$29,530
7	$33,270
8	$37,010
8+	Add $3,740 for each additional person.
* Alaska and Hawaii have slightly higher poverty guidelines.

 

In addition to determining eligibility for purposes of many federal programs, many health care and social services organizations, especially non-profit organizations, utilize a sliding fee scale or fee waiver based on the federal poverty guidelines.  In addition, many health care organizations base their charitable care policies on the federal poverty guidelines.  For programs where the use of federal poverty guidelines is optional, organizations may want to evaluate whether business or operational needs or other considerations merit any adjustment or use of alternative standards at this time.

While use of the federal poverty guidelines is not mandated by law except by federally funded programs, the Joint Commission as part of its accreditation and survey process may ask whether the organization has utilized the most recent update to the federal poverty guidelines in its sliding scale or fee waiver policies.  Therefore, hospitals and other organizations subject to Joint Commission or other accreditation relying on the Federal Poverty Guidelines should review their charity care or fee waiver policies and monitor for planned updates.

Solutions Law Press author and Curran Tomko and Tarski LLP Health Care Practice Chair Cynthia Marcotte Stamer has extensive experience advising and assisting health care practitioners and other businesses and business leaders to establish, administer, investigate and defend health care fraud and other compliance and internal control policies and practices to reduce risk under federal and state health care and other laws. You can get more information about the CTT Health Care Practice and Ms. Stamer’s health industry experience here.

If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Cynthia Marcotte Stamer, CTT Health Care Practice Group Chair, at cstamer@cttlegal.com, 214.270.2402or another Curran Tomko Tarski LLP attorney of your choice.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in other updates on HEAT activities such as the following:

• OIG Special Fraud Alert Targets DME Telemarketing
• Federal HEAT & Other Federal Health Care Fraud Efforts Score More Than 15 Successes As OIG Claims $20.97 Billion Saved From Enforcement Activities In December
• HHS Advisory Committee on Genetics, Health, and Society To Host Public Meeting February 4-5, 2010
• HEAT Initiative Snares Health Fraud Related Guilty Pleas of Physical Therapist, Money Launderer and Patient Recruiter In Detroit
• HIT Policy Committee’s Nationwide Health Information Network Workgroup Meets December 16, 2009
• Chisholm Trail Chapter Association of Certified Fraud Specialists December 11, 2009 Chapter Meeting & Luncheon Invite
• Medicare Paid Physicians More Than $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative
• OIG Review of High-Dollar Medicare Part D Payments Processed by First Coast Service Options, Inc. Shows Overpayments
• Renal Dialysis Faculties Encouraged to Review Current Protocols for Administering Erthropoiesis-Stimulating Agents
• OCR Requires Health Care Providers To Improve Services for Limited English Speakers, Hearing Impaired As HHS Steps Up Enforcement of Federal Discrimination Laws

If you or someone else you know would like to receive future updates about developments on these and other concerns, please register to receive this Solutions Law Press Health Care Update here and be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile at here. You can access other recent updates and other informative publications and resources provided by Curran Tomko Tarski LLP attorneys and get information about its attorneys’ experience, briefings, speeches and other credentials here.

For important information concerning this communication click here.  If you do not wish to receive these updates in the future, send an e-mail with the word “Remove” in the Subject here.

©2009 Cynthia Marcotte Stamer.  All rights reserved. 

OIG Special Fraud Alert Targets DME Telemarketing

By Cynthia Marcotte  Stamer 

The Department of Health & Human Services (HHS) Office of Inspector General (OIG) on January 14, 2010 issued a Special Fraud Alert discussing potential violations of the anti-kickback statute for Federal health care programs durable medical equipment (DME) suppliers making unsolicited telephone calls to Medicare beneficiaries prematurely based only on physicians’ preliminary written or verbal orders or otherwise inappropriately.  DME companies and their telemarketing providers should review their current practices in light of the Special Fraud Alert and tighten practices as necessary to comply with its guidance.

The January 14, 2010 Special Fraud Alert focuses on the continuing efforts by some DME companies to circumvent the telemarketing prohibits on Section 1834(a)(17) by using independent marketing firms to make unsolicited telephone calls to Medicare beneficiaries to telemarket DME based on preliminary written or oral DME orders of physicians.  DME companies and their telemarketing providers should review their current practices in light of the Special Fraud Alert and tighten practices as necessary to comply with its guidance.  Read more here

Over the past year, HHS, the Department of Justice and other federal officials have significantly turned up the heat on health care fraud investigation and enforcement,  During December, 2010 alone, the Department of Justice reported more than 15 criminal fraud enforcement actions. See Federal HEAT & Other Federal Health Care Fraud Efforts Score More Than 15 Successes As OIG Claims $20.97 Billion Saved From Enforcement Activities In December.  These and other reports document the rising prosecution and enforcement risks that health care providers face for failing under federal health care fraud laws.  In light of the growing enforcement and emphasis of federal prosecutors and regulations on the detection and prosecution of organizations and individuals participating in billing or other activities that violate federal health care fraud laws, health care organizations, their officers, directors, employees, consultants and other business partners should tighten practices and step up oversight to minimize the likelihood that they or their organizations will engage in activities that federal regulators view as federal health care fraud.  Health care providers need to strengthen existing practices to withstand federal scrutiny, as well as to identify appropriate counsel, established plans and procedures and implement other arrangements for responding in the event the Department of Justice, HHS or other federal regulators audit or take other action regarding their practices or billings.

For More Information

We hope that this information is useful to you.  If you found these updates of interest, you also be interested in other updates on HEAT activities such as the following:

• HEAT Initiative Snares Health Fraud Related Guilty Pleas of Physical Therapist, Money Launderer and Patient Recruiter In Detroit
• 8 Miami-Area Residents Charged, Assets Frozen in $22 Million Home Health Medicare Fraud Scheme
• 53 Doctors, Health Care Executives & Beneficiaries Indicted For Involvement In A $50 Million Alleged False Billing Ring

If you need assistance with these or other health care fraud, compliance, reimbursement, risk management, workforce and other health care concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

Federal HEAT & Other Federal Health Care Fraud Efforts Score More Than 15 Successes As OIG Claims $20.97 Billion Saved From Enforcement Activities In December

As the interagency Medicare Fraud Strike Force targeting Medicare Fraud scored another series of more than 15 successful criminal enforcement actions across the national during December, 2009, the Department of Health & Human Services (HHS) Office of Inspector General (OIG) credited the Medicare Fraud Strike Force and other stepped up oversight and enforcement activities as helping it achieve $20.97 Billion in Medicare and other federal health care program savings during Fiscal Year 2009 in its Semiannual Report to Congress. 

The Detroit convictions were among three of more than 15 other criminal enforcement successes reported by the Department of Justice during December.  These and other reports document the rising prosecution and enforcement risks that health care providers face for failing to tailor their billing and other practices to comply with federal health care fraud laws.  In light of the growing enforcement and emphasis of federal prosecutors and regulations on the detection and prosecution of organizations and individuals participating in billing or other activities that violate federal health care fraud laws, health care organizations, their officers, directors, employees, consultants and other business partners should tighten practices and step up oversight to minimize the likelihood that they or their organizations will engage in activities that federal regulators view as federal health care fraud.

December 13 Detroit Criminal Convictions

The U.S. Department of Justice Criminal Division (Justice Department), Federal Bureau of Investigation (FBI) and Inspector General for the U.S. Department of Health and Human Services (HHS) jointly announced Friday (December 11, 2009) that Baskaran Thangarasan, Sandeep Aggarwal and Wayne Smith had plead guilty for their roles in connection with several Detroit-area health care fraud scheme.

On December 9, 2009, Thangarasan plead guilty to one count of conspiracy to commit health care fraud and Aggarwal plead guilty to one count of conspiracy to launder money. On December 11, 2009, Smith plead guilty to one count of conspiracy to commit health care fraud.

• Thangarasan Guilty Plea To Conspiracy To Commit Health Care Fraud

On December 9, 2009, Thangarasan plead guilty to one count of conspiracy to commit health care fraud. And Aggarwal plead guilty to one count of conspiracy to launder money. He faces a maximum sentence of 10 years in prison and a $250,000 fine at sentencing.

According to information contained in plea documents, Thangarasan, a licensed physical therapist, admitted that he began working in approximately September 2003 as a contract therapist for a co-conspirator. This co-conspirator owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Thangarasan admitted that he, the co-conspirator and others created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by Thangarasan’s co-conspirators.

Thangarasan admitted that his role in creating the fictitious therapy files was to sign documents and progress notes indicating he had provided physical therapy services to particular Medicare beneficiaries, when in fact he had not. Thangarasan was paid approximately $50 by co-conspirators per file that he falsified in this manner. Thangarasan also admitted that in the course of the scheme charged in the indictment, he signed approximately 1,011 fictitious physical therapy files, falsely indicating he had provided physical therapy services to Medicare beneficiaries. Thangarasan admitted he knew that the files he helped falsify were used to justify fraudulent billings to Medicare.

In addition, Thangarasan admitted that between approximately September 2003 and May 2006, his co-conspirators submitted claims to the Medicare program totaling approximately $5,055,000 for files that were falsified by Thangarasan. Medicare actually paid approximately $2,325,000 on those claims. Thangarasan admitted that throughout the conspiracy, he was fully aware that Medicare was being billed for occupational therapy services he had falsely indicated he had performed.

• Aggarwal Guilty Plea to Money Laundering

Aggarwal faces a maximum sentence of 20 years in prison and a $500,000 fine after admitting in the same case to assisting co-conspirator Suresh Chand in laundering the proceeds of Chand’s Medicare fraud scheme. Chand, who pleaded guilty in September 2009 to conspiracy to commit health care fraud and conspiracy to launder money, admitted to conspiring to submit approximately $18 million in fraudulent physical and occupational therapy claims to the Medicare program. Aggarwal, who admitted working at Chand’s office, acknowledged that his role in the scheme was to set up sham entities at Chand’s direction, with the purpose of using those entities to distribute the proceeds of the fraud to the various co-conspirators. According to plea documents, one such entity was called Global Health Care Management Services. Aggarwal admitted that Global Health Care Management Services, which he helped create, provided no health or management services of any type, but existed solely as a mechanism to conceal the location of fraudulently obtained Medicare proceeds. Aggarwal admitted in his plea that he and Chand laundered approximately $393,000 through this sham entity.

• Smith Guilty Plea To Conspiracy To Commit Health Care Fraud

At sentencing, Smith face a maximum sentence of 10 years in prison and a $250,000 fine for his participation in a scheme to falsely bill Medicare.  His indictment charged that he transported and paid Medicare beneficiaries to attend Sacred Hope Center, a Southfield, Mich.-infusion clinic. According to the indictment, the Medicare beneficiaries he paid and transported were paid to sign paperwork indicating that they had received infusions and injections of specialty medications that they did not in fact receive.

According to the indictment, Sacred Hope Center routinely billed the Medicare program for services that were medically unnecessary and/or never provided. The primary owners and operators of Sacred Hope Center have pleaded guilty and admitted purchasing only a small fraction of the medications that the clinic billed the Medicare program for providing. These co-conspirators have also stated that patients were prescribed medications at the clinic based not on medical need, but instead based on which medications were likely to generate Medicare reimbursements.

Other Criminal Enforcement Actions During December

The Detroit convictions are three of nearly 20 successful criminal enforcement activities that DOJ announced during December, 2009.  During the same month, DOJ also announced:

• On December 20, 2009, sentencing of an Audiologist to six months in prison for Medicare Fraud in California  here
• On December 17, 2009 , the guilty plea and sentencing of a Houston physician for operating an illegal pill mill here
• On December 16, 2009, the sentencing in Michigan of the owner of health care agency to 18 months prison in Medicare kickback scheme here
• On December 15, 2009, the sentencing of a Lexington. South Carolina doctor to perform community service in a health care fraud case  here
• On December 15, 2009, the guilty plea of a Plymouth, Minnesota man to defrauding Medicaid out of $74,000  here
• On December 14, 2009, the sentencing of a Miami, Georgia man to more than a decade in Federal prison for million dollar Medicaid fraud here
• On December 11, 2009, the charging of a durable medical equipment company and six other defendants in Pennsylvania in a Medicare Fraud And Kickback Scheme here
• On December 11, 2009, the guilty plea of an Aulander, North Carolina woman to $650,000 Health Care Fraud  here
• On December 7, 2009, the guilty plea of a corporation various health care fraud schemes here
• On December 6, 2009, the guilty plea of a Dallas, Texas durable medical equipment business owner to aggravated id theft in a Medicare Fraud scheme  here
• On December 3, 2009, the arrest of the owner of a Florida home health care provider and his alleged accomplice for a scheme to bribe a government contractor  here
• On December 3, 2009, the conviction of two defendants for Health Care Fraud in Idaho here
• On December 2, 2009, the entry of an order requiring a Sioux City, Iowa hospital to pay $400,000 to resolve false claims allegations  here
• On December 1, 2009, the admission by a Maryland man to health care fraud on a hospital in the District of Columbia  here
• On December 1, 2009, the arrest of a Miami, Florida man for obstructing a Health Care Fraud Investigation here
• On December 1, 2009, the $125,000  fine of a Michigan chiropractor for Falsifying Records here

HEAT Operations Continued & Expanded

The Detroit and many of these other criminal successes resulted from joint investigations by the FBI and the OIG as part of the Medicare Fraud Strike Force as part of various interagency Medicare Fraud “Strike Forces” operating in several regions of the U.S. as part of the continuing Health Care Fraud Prevention and Enforcement Action Team (HEAT) operations of the FBI, HHS and the Justice Department which DOJ credits with producing more than 250 criminal convictions since their inception,  Based on initial successes of Strike Force operations in Miami (Phase One) and  Los Angeles (Phase Two), the Justice Department and HHS on May 20, 2009 expanded the scope of these operations to include Detroit and Houston Strike Force teams. Recently, DOJ and HHS announced the expansion of its HEAT operations to include Strike Force teams also targeting health care fraud in Brooklyn, New York; Tampa, Florida and Baton Rouge, Louisiana.

The heightened emphasis on enforcement of federal health care fraud laws reflected in the HEAT program the enactment of recent amendments to the False Claims Act, 31 U.S.C. § 3729 (FCA)  under the “Fraud Enforcement and Recovery Act of 2009”(FERA).  The FERA amendments increase the likelihood both that whistleblowers will turn in health care providers and other individuals and organizations that file false claims in violation of the FCA and the liability that violators may incur for that misconduct.

The FERA amendments and the HEAT Team and Strike Force activities are part of a broader emphasis in the enforcement of federal health care fraud laws by both the Administration and Congress.  President Obama’s proposed Fiscal Year 2010 budget seeks to further increase funding for fraud prevention and enforcement by investing $311 million — a 50 percent increase from 2009 funding — to strengthen program integrity activities within the Medicare and Medicaid programs.  The Obama Administration anticipates that all combined, the anti-fraud efforts in the President’s budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs, including the Medicare Advantage and Medicare prescription drug programs.  Many state agencies also are stepping up their health care fraud investigations and enforcement.

Health Care Providers Must Step Up Compliance & Risk Management

In light of this new emphasis upon health care fraud detection and enforcement, health care providers now more than ever need to prepare to demonstrate the appropriateness and defensibility of their health care billing and other compliance efforts.

Solutions Law Press author and Curran Tomko and Tarski LLP Health Care Practice Chair Cynthia Marcotte Stamer has extensive experience advising and assisting health care practitioners and other businesses and business leaders to establish, administer, investigate and defend health care fraud and other compliance and internal control policies and practices to reduce risk under federal and state health care and other laws. You can get more information about the CTT Health Care Practice  and more specifics about Ms. Stamer’s health industry experience here on the CTT Website.

If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Cynthia Marcotte Stamer, CTT Health Care Practice Group Chair, at cstamer@cttlegal.com, 214.270.2402, CTT White Collar Defense Litigation Practice Chair Edwin J. Tomko at etomko@cttlegal.com, or  214.270.1405 or another Curran Tomko Tarski LLP attorney of your choice.. 

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in other updates on HEAT activities such as the following:

• HEAT Initiative Snares Health Fraud Related Guilty Pleas of Physical Therapist, Money Launderer and Patient Recruiter In Detroit
• 8 Miami-Area Residents Charged, Assets Frozen in $22 Million Home Health Medicare Fraud Scheme
• 53 Doctors, Health Care Executives & Beneficiaries Indicted For Involvement In A $50 Million Alleged False Billing Ring

Other recent updates that also may be of interested published on our electronic Solutions Law Press Health Care Update publication include:

• HIT Policy Committee’s Nationwide Health Information Network Workgroup Meets December 16, 2009
• Chisholm Trail Chapter Association of Certified Fraud Specialists December 11, 2009 Chapter Meeting & Luncheon Invite
• Medicare Paid Physicians More Than $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative
• OIG Review of High-Dollar Medicare Part D Payments Processed by First Coast Service Options, Inc. Shows Overpayments
• Renal Dialysis Faculties Encouraged to Review Current Protocols for Administering Erthropoiesis-Stimulating Agents
• 2010 Medicare Part B Monthly Premium Rate, Annual Part B Deductible & Actuarial  RatesAnnounced
• 2010 Medicare Hospital (Part A) Premiums, Inpatient Deductibles & Copays Announced
• CMS Renews Community Health Accreditation Program Authority To Accredit Hospices
• CMS Proposes Changes To Medicare Advantage and Medicare Prescription Drug Program Rules
• Forms & Instructions To Provide HITECH Act-Required Notice To OCR Of Breach of Unsecured Protected Health Information Posted
• Patient Protection Act Confidentiality Breaches To Rise To $11,000
• Health Care Providers & Other HIPAA Covered Entities Must Comply With New Data Breach Rules By September 23
• OCR Requires Health Care Providers To Improve Services for Limited English Speakers, Hearing Impaired As HHS Steps Up Enforcement of Federal Discrimination Laws

If you or someone else you know would like to receive future updates about developments on these and other concerns, please register to receive this Solutions Law Press Health Care Update here and be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile at here. You can access other recent updates and other informative publications and resources provided by Curran Tomko Tarski LLP attorneys and get information about its attorneys’ experience, briefings, speeches and other credentials here.

For important information concerning this communication click here.  If you do not wish to receive these updates in the future, send an e-mail with the word “Remove” in the Subject here.

©2009 Cynthia Marcotte Stamer.  All rights reserved. 

HHS Advisory Committee on Genetics, Health, and Society To Host Public Meeting February 4-5, 2010

The Department of Health & Human Services (HHS) plans to hold a public meeting of the Secretary’s Advisory Committee on Genetics, Health, and Society (SACGHS) of the U.S. Public Health Service on February 4-5, 2009.   The meeting will offer the opportunity for members of the public to attend the meeting on a space available basis or to view a Webcast.

The SACGHS  meeting will be held from 8:30 a.m. to approximately 5:30 p.m. on Thursday, February 4, 2010, and from 8 a.m. to approximately 3 p.m. on Friday, February 5, 2010, at the Omni Shoreham Hotel, 2500 Calvert Street, NW., Washington, DC 20008.

The announced agenda items include:

• The review of a revised report on gene patents and licensing practices;
• The review of a public consultation draft report on genetics education and training;
• An information-gathering session on the mechanisms and policies related to genomic data sharing;
• A preliminary discussion to help plan a future session on implications of an affordable genome;
• A report on activities of the Clinical Utility and Comparative Effectiveness Task Force; and
• Updates from Federal agencies on activities related to the implementation of the Genetic Information Nondiscrimination Act, the coverage and reimbursement of genetic tests, the oversight of genetic testing, and the retention and use of residual dried blood spot specimens after newborn screening.

For more information about registration for the meeting, submission of comments and other details, here.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

HEAT Initiative Snares Health Fraud Related Guilty Pleas of Physical Therapist, Money Launderer and Patient Recruiter In Detroit

By Cynthia Marcotte Stamer

The interagency Medicare Fraud Strike Force targeting Medicare Fraud in the Detroit area scored another series of criminal convictions last week. 

The U.S. Department of Justice Criminal Division (Justice Department), Federal Bureau of Investigation (FBI) and Inspector General for the U.S. Department of Health and Human Services (HHS) jointly announced Friday (December 11, 2009) that Baskaran Thangarasan, Sandeep Aggarwal and Wayne Smith had plead guilty for their roles in connection with several Detroit-area health care fraud scheme.

On December 9, 2009, Thangarasan plead guilty to one count of conspiracy to commit health care fraud and Aggarwal plead guilty to one count of conspiracy to launder money. On December 11, 2009, Smith plead guilty to one count of conspiracy to commit health care fraud.

Thangarasan Guilty Plea To Conspiracy To Commit Health Care Fraud

On December 9, 2009, Thangarasan plead guilty to one count of conspiracy to commit health care fraud. And Aggarwal plead guilty to one count of conspiracy to launder money. He faces a maximum sentence of 10 years in prison and a $250,000 fine at sentencing.

According to information contained in plea documents, Thangarasan, a licensed physical therapist, admitted that he began working in approximately September 2003 as a contract therapist for a co-conspirator. This co-conspirator owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Thangarasan admitted that he, the co-conspirator and others created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by Thangarasan’s co-conspirators.

Thangarasan admitted that his role in creating the fictitious therapy files was to sign documents and progress notes indicating he had provided physical therapy services to particular Medicare beneficiaries, when in fact he had not. Thangarasan was paid approximately $50 by co-conspirators per file that he falsified in this manner. Thangarasan also admitted that in the course of the scheme charged in the indictment, he signed approximately 1,011 fictitious physical therapy files, falsely indicating he had provided physical therapy services to Medicare beneficiaries. Thangarasan admitted he knew that the files he helped falsify were used to justify fraudulent billings to Medicare.

In addition, Thangarasan admitted that between approximately September 2003 and May 2006, his co-conspirators submitted claims to the Medicare program totaling approximately $5,055,000 for files that were falsified by Thangarasan. Medicare actually paid approximately $2,325,000 on those claims. Thangarasan admitted that throughout the conspiracy, he was fully aware that Medicare was being billed for occupational therapy services he had falsely indicated he had performed.

Aggarwal Guilty Plea to Money Laundering

Aggarwal faces a maximum sentence of 20 years in prison and a $500,000 fine after admitting in the same case to assisting co-conspirator Suresh Chand in laundering the proceeds of Chand’s Medicare fraud scheme. Chand, who pleaded guilty in September 2009 to conspiracy to commit health care fraud and conspiracy to launder money, admitted to conspiring to submit approximately $18 million in fraudulent physical and occupational therapy claims to the Medicare program. Aggarwal, who admitted working at Chand’s office, acknowledged that his role in the scheme was to set up sham entities at Chand’s direction, with the purpose of using those entities to distribute the proceeds of the fraud to the various co-conspirators. According to plea documents, one such entity was called Global Health Care Management Services. Aggarwal admitted that Global Health Care Management Services, which he helped create, provided no health or management services of any type, but existed solely as a mechanism to conceal the location of fraudulently obtained Medicare proceeds. Aggarwal admitted in his plea that he and Chand laundered approximately $393,000 through this sham entity.

Smith Guilty Plea To Conspiracy To Commit Health Care Fraud

At sentencing, Smith face a maximum sentence of 10 years in prison and a $250,000 fine for his participation in a scheme to falsely bill Medicare.  . 

Smith pleaded guilty to an indictment that charged he transported and paid Medicare beneficiaries to attend Sacred Hope Center, a Southfield, Mich.-infusion clinic. According to the indictment, the Medicare beneficiaries he paid and transported were paid to sign paperwork indicating that they had received infusions and injections of specialty medications that they did not in fact receive.

According to the indictment, Sacred Hope Center routinely billed the Medicare program for services that were medically unnecessary and/or never provided. The primary owners and operators of Sacred Hope Center have pleaded guilty and admitted purchasing only a small fraction of the medications that the clinic billed the Medicare program for providing. These co-conspirators have also stated that patients were prescribed medications at the clinic based not on medical need, but instead based on which medications were likely to generate Medicare reimbursements.

HEAT Operations Continuing

The cases are being investigated by the FBI and the HHS Office of the Inspector General. Theses cases were brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and U.S. Attorney’s Office for the Eastern District of Michigan.

The investigation resulting in these guilty pleas were conducted as part of a series of interagency Medicare Fraud “Strike Forces” operating in several regions of the U.S. as part of the continuing Health Care Fraud Prevention and Enforcement Action Team (HEAT) operations of HHS and the Justice Department.  Based on initial successes of Strike Force operations in Miami (Phase One) and  Los Angeles (Phase Two), the Justice Department and HHS on May 20, 2009 expanded the scope of these operations to include Detroit and Houston Strike Force teams.

The heightened emphasis on enforcement of federal health care fraud laws reflected in the HEAT program the enactment of recent amendments to the False Claims Act, 31 U.S.C. § 3729 (FCA)  under the “Fraud Enforcement and Recovery Act of 2009”(FERA).  The FERA amendments increase the likelihood both that whistleblowers will turn in health care providers and other individuals and organizations that file false claims in violation of the FCA and the liability that violators may incur for that misconduct.

The FERA amendments and the HEAT Team and Strike Force activities are part of a broader emphasis in the enforcement of federal health care fraud laws by both the Administration and Congress.  President Obama’s proposed Fiscal Year 2010 budget seeks to further increase funding for fraud prevention and enforcement by investing $311 million — a 50 percent increase from 2009 funding — to strengthen program integrity activities within the Medicare and Medicaid programs.  The Obama Administration anticipates that all combined, the anti-fraud efforts in the President’s budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs, including the Medicare Advantage and Medicare prescription drug programs.  Many state agencies also are stepping up their health care fraud investigations and enforcement.

In light of this new emphasis upon health care fraud detection and enforcement, health care providers now more than ever need to prepare to demonstrate the appropriateness and defensibility of their health care billing and other compliance efforts.

Solutions Law Press author and Curran Tomko and Tarski LLP Health Care Practice Chair Cynthia Marcotte Stamer has extensive experience advising and assisting health care practitioners and other businesses and business leaders to establish, administer, investigate and defend health care fraud and other compliance and internal control policies and practices to reduce risk under federal and state health care and other laws. You can get more information about her health industry experience here.  

If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Cynthia Marcotte Stamer, CTT Health Care Practice Group Chair, at cstamer@cttlegal.com, 214.270.2402 or your other favorite Curran Tomko Tarski LLP attorney. 

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in other updates on HEAT activities such as the following:

• 8 Miami-Area Residents Charged, Assets Frozen in $22 Million Home Health Medicare Fraud Scheme
• 53 Doctors, Health Care Executives & Beneficiaries Indicted For Involvement In A $50 Million Alleged False Billing Ring

Other recent updates that also may be of interested published on our electronic Solutions Law Press Health Care Update publication include:

• HIT Policy Committee’s Nationwide Health Information Network Workgroup Meets December 16, 2009
• Chisholm Trail Chapter Association of Certified Fraud Specialists December 11, 2009 Chapter Meeting & Luncheon Invite
• Medicare Paid Physicians More Than $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative
• OIG Review of High-Dollar Medicare Part D Payments Processed by First Coast Service Options, Inc. Shows Overpayments
• Renal Dialysis Faculties Encouraged to Review Current Protocols for Administering Erthropoiesis-Stimulating Agents
• 2010 Medicare Part B Monthly Premium Rate, Annual Part B Deductible & Actuarial  RatesAnnounced
• 2010 Medicare Hospital (Part A) Premiums, Inpatient Deductibles & Copays Announced
• CMS Renews Community Health Accreditation Program Authority To Accredit Hospices
• CMS Proposes Changes To Medicare Advantage and Medicare Prescription Drug Program Rules
• Forms & Instructions To Provide HITECH Act-Required Notice To OCR Of Breach of Unsecured Protected Health Information Posted
• Patient Protection Act Confidentiality Breaches To Rise To $11,000
• Health Care Providers & Other HIPAA Covered Entities Must Comply With New Data Breach Rules By September 23
• OCR Requires Health Care Providers To Improve Services for Limited English Speakers, Hearing Impaired As HHS Steps Up Enforcement of Federal Discrimination Laws

If you or someone else you know would like to receive future updates about developments on these and other concerns, please register to receive this Solutions Law Press Health Care Update here and be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile at here. You can access other recent updates and other informative publications and resources provided by Curran Tomko Tarski LLP attorneys and get information about its attorneys’ experience, briefings, speeches and other credentials here.

For important information concerning this communication click here.  If you do not wish to receive these updates in the future, send an e-mail with the word “Remove” in the Subject here.

©2009 Cynthia Marcotte Stamer.  All rights reserved. 

HIT Policy Committee’s Nationwide Health Information Network Workgroup Meets December 16, 2009

The Office of the National Coordinator for Health Information Technology (ONC) HIT Policy Committee’s Nationwide Health Information Network Workgroup will hold a public meeting on December 16, 2009.  The meeting is scheduled from 10 a.m. to 5 p.m./Eastern Time at the OMNI Shoreham Hotel, 2500 Calvert Street, NW., Washington, DC. Members of the public care invited to participate live, via telephone, or Webcast.  For details about options for participation, instructions to present input, and other details, see here.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

Chisholm Trail Chapter Association of Certified Fraud Specialists December 11, 2009 Chapter Meeting & Luncheon Invite

The Chisholm Trail Chapter of the Association of Certified Fraud specialists invites members and other interested persons to attend its December 11, 2009 Chapter Meeting on December 11, 2009 beginning at 10:30 a.m. in the DCIS Conference Room located at 2201 N. Collins, Arlington, TX.

Interested persons should RSVP to and arrange for the required registration fee for the pre-paid luncheon (barbecue w/fixings) in the amount of $12.00 per person to be made payable to and received by the following no later than December 4, 2009:

Make checks payable to: Carlos Ontiveros, POB 227238, Dallas, Tx 75222-7238

To RSVP or for additional information, please e-mail here.

 We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

Medicare Paid Physicians More Than $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative

Announcement Follows CMS’s Release of 2010 PQRI Program Details

More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, up from the $36 million paid in 2007, according to a new Centers for Medicare & Medicaid Services (CMS) report.  The announcement of the 2008 statistics follows CMS’s recent announcement of its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule.  A fact sheet on the 2010 PQRI Program is available online at here.  CMS reports it excepts the PQRI Program will continue to improve quality and provider participation will rise in 2009 and 2010.

According to CMS, physicians and other eligible professionals qualified for an incentive payment for the 2008 PQRI by satisfactorily reporting the required PQRI quality measures data received their payments this Fall.  CMS reports that:

• The number of eligible professionals who earned an incentive payment during 2008 increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment.  In 2007, eligible professionals could only participate in the program during a 6-month reporting period.  In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.
• The average incentive amount for individual professionals was over $1,000, with the largest payment to an eligible professional totaling over $98,000.
• More than 162,800 professionals participated in the 2008 PQRI. Of those, over 85,000 physicians and other eligible professionals met statutory requirements for satisfactory reporting for the 2008 reporting period and are receiving incentive payments. 
• Eligible professionals from all U.S. states and territories participated in PQRI in 2008.  Health practices with participating eligible professionals in Florida and Illinois received the highest incentive payments for the 2008 PQRI.  In Florida, eligible professionals received a total of over $7.5 million, and in Illinois, they received over $6 million.

Additional 2008 PQRI results, as well as information on how eligible professionals who participated in the 2008 PQRI, can access confidential feedback reports can be found in a CMS Fact Sheet here.

Established in late 2006 by the Tax Relief and Health Care Act, PQRI is a voluntary program that allows physicians and other eligible healthcare professionals to receive incentive payments for reporting data on quality measures related to services furnished to Medicare beneficiaries.  In the initial program years, physicians and other eligible professionals who satisfactorily submitted quality data for covered professional services furnished in the applicable reporting period were able to receive incentive payments of 1.5 percent of the total estimated allowed charges under Medicare Part B for covered professional services. In 2008 Congress extended the PQRI under the Medicare Improvements for Patients and Providers Act (MIPPA) and authorized incentive payments through 2010.

While the 2008 PQRI program included positive changes to ease the reporting of quality measures, CMS anticipates that the 2009 PQRI program provides enhancements that will make it even easier for physicians and other health care professionals to participate. Beginning in 2009, Congress increased the incentive that eligible professionals could receive for satisfactorily reporting data from 1.5 percent to 2.0 percent of the estimate of the allowed charges under Medicare Part B for all such covered professional services furnished during the applicable reporting period for 2009 and 2010.  CMS added 52 new quality measures for the 2009 PQRI year, raising the total number of measures to 153.  These new measures cover all types of healthcare professionals who provide services to Medicare beneficiaries, and address areas such as osteoarthritis, back pain, coronary artery disease, and HIV/AIDS, as well as 18 measures that must be reported exclusively through PQRI-qualified registries.  CMS hopes its recently announced 2010 PQRI Program will result in enhanced quality and further participation by physicians and other providers in 2010.

More information about the PQRI program, including participation guidance and the criteria to qualify for an incentive payment is available at www.cms.hhs.gov/PQRI.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

OIG Review of High-Dollar Medicare Part D Payments Processed by First Coast Service Options, Inc. Shows Overpayments

The Office of Inspector General (OIG) is reporting that its review of certain high dollar Medicare Part B payments processed by First Coast Service Options, Inc., for Calendar Years 2004−2006  shows overpayments. 

According to  OIG Audit Report A-01-09-00513 posted at  http://www.oig.hhs.gov/oas/reports/region1/10900513.pdf, OIG found during calendar years 2004 through 2006 that First Coast Service Options, Inc. overpaid providers $114,783 for high-dollar (greater than $10,000) Medicare Part B claims.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here,  by subscribing to receive these updates in blog form here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

Renal Dialysis Faculties Encouraged to Review Current Protocols for Administering Erthropoiesis-Stimulating Agents

Renal Dialysis Facilities are encouraged to review and consider the advisability for further tightening of their current practices in light of the Renal Dialysis Facilities’ Dosage Protocols for Administering Erthropoiesis-Stimulating Agents, (OEI-03-09-00010), posted by the OIG this week. 

According to the report, OIG conducted the report in response to a request from Chairman Fortney Pete Stark of the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives in response to reported concerns by some members of Congress that dialysis facilities’ protocols for administering ESAs may not be consistent with the current boxed warning for these drugs. 

OIG found that 93 percent of Medicare-certified dialysis facilities had protocols in place for administering erythropoiesis-stimulating agents (ESA), but only 56 percent of the facilities’ protocols explicitly state a target hemoglobin range.  OIG could not determine whether the remaining 44 percent of protocols were consistent with the boxed warning and Medicare’s benefit policy because they do not specify a target hemoglobin range.  Of the protocols that state a target hemoglobin range, 94 percent are consistent with the boxed warning on FDA-approved labeling and the Medicare benefit policy for ESAs. 

While noting they are not required to do so, OIG commented that dialysis facilities may develop their own protocols for administering ESAs to patients with chronic kidney failure.  The protocols may define target hemoglobin levels and dosage instructions for administering ESAs.  According to the boxed warning on ESAs’ labels, maintaining higher rather than lower hemoglobin levels in a patient with chronic kidney failure can adversely affect the patient’s health and increase the risk of death.  Specifically, the boxed warning states that providers should administer ESAs “to achieve and maintain hemoglobin levels within the range of 10 to 12 g/dL.”  The Medicare benefit policy for ESAs reflects the target hemoglobin range specified in the boxed warning.  A separate Medicare policy for monitoring ESA payments states that CMS will reduce reported dosages upon which ESA claims are paid when patients’ hemoglobin levels exceed 13g/dL.

OIG reported its review of protocols to determine whether they are consistent with selected guidelines on ESAs’ labels revealed that some protocols contain information that differs from labeling guidelines regarding starting doses, dose adjustments, and withholding ESA doses.  OIG also found that all of the protocols that include a target hemoglobin range or level at which to increase ESA doses conform with CMS’s monitoring policy.

OIG concluded that although its review does not address the amount of ESAs that providers actually administer to patients at their dialysis facilities, it does demonstrate that just over half of facilities’ protocols for administering ESAs are consistent with the boxed warning and Medicare’s benefit policy for ESAs.  However, since almost half of the dialysis facilities either did not have protocols or did not specify a target hemoglobin range in their protocols, OIG reported it could not determine whether these facilities’ policies target the hemoglobin range outlined in the boxed warning that FDA requires on ESA labels.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here,  by subscribing to receive these updates in blog form here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

 

North Texas Healthcare Compliance Professional Association Meets Nov. 10 At Medical City

Note New Meeting Time And Change Of Room Location!!!

November 10, 2009 Meeting Announcement & Agenda

3:00 – 5:00 p.m.

Medical City Hospital Cafetorium in Building A next to the Cafeteria

7777 Forrest Lane, Dallas, Texas

 The North Texas Healthcare Compliance Professional Association invites members and other interested health industry compliance professionals to its November 10, 2009 meeting to be held from 3:00 – 5:00 p.m. in the Cafetorium located in Building A next to the cafeteria at Medical City, 7777 Forrest Lane, Dallas, Texas. Please note the adjusted time and room location for this meeting!

Topics to be discussed include:

• An update on modifications/upgrades in Group One’s Compliance Check and the ability to use the Data Initiative to pull RAC specific indicators and a dashboard in development for Compliance Officer use from Kristin Jenkins of the Dallas/Hospital Council; and
• An update on “Emerging Issues & Trends in Medical Practice Valuations” by Don Barbo, Health Care Valuation Services Director, MidAmerica, Deloitte Financial Advisory Services, LLP.

 Complementary participation in the meeting is open to all NTHCPA members and other interested health care compliance professionals.  Please feel free to share this invitation with others who may be interested.

NTHCPA thanks Texas Health Resources for hosting the October 13, 2009 Meeting and Medical City for hosting the November 10, 2009 meeting.  

If you are interested in hosting one of the upcoming meetings, wish to suggest topics or speakers, or wish to obtain or share other information, please contact NTHCPA Vice-President Cynthia Marcotte Stamer at (214) 270-2402 or by e-mail at cstamer@solutionslawyer.net.

We look forward to seeing you at the meeting!

About the NTHCPA

NTHCPA exists to champion ethical practice and compliance standards and to provide the necessary resources for ethics and compliance Professionals and others in North Texas who share these principles.

The vision of NTHCPA is to be a pre-eminent compliance and ethics group promoting lasting success and integrity of organizations within North Texas.

To register or update your registration or to receive notice of future meetings, e-mail here.

This communication may be considered a marketing communication for certain purposes.  If you wish to update your e-mail for purposes of or would prefer not to receive future e-mail concerning meetings or other activities of the North Texas Healthcare Compliance Professionals Association or other marketing and promotional mailings from it, please send an email with the word “unsubscribe” in its subject heading  here.

2010 Medicare Part B Monthly Premium Rate, Annual Part B Deductible & Actuarial RatesAnnounced

The Centers for Medicare & Medicaid Services recently announced that the monthly premiums, actuarial rates for aged (age 65 and over) and disabled (under age 65) beneficiaries enrolled in Part B of the Medicare Supplementary Medical Insurance (SMI) program that will apply for calendar year 2010. 

The rates announced here in the Federal Register on October 22, 2009 are as follows:

• The monthly actuarial rates for 2010 are $221.00 for aged enrollees and $270.40 for disabled enrollees. The standard monthly Part B premium rate for 2010 is $110.50, which is up from the 2009
• standard premium rate of $96.40.)
• The Part B deductible for 2010 is set at $155.00 for all Part B beneficiaries.

A beneficiary who has to pay an income-related monthly adjustment may have to pay a total monthly premium of roughly 35, 50, 65 or 80 percent of the total cost of Part B coverage.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved.

2010 Medicare Hospital (Part A) Premiums, Inpatient Deductibles & Copays Announced

The Centers for Medicare & Medicaid Services (CMS) recently announced that the Medicare Hospital Insurance (Part A) premium for uninsured enrollees in calendar year (CY) 2010 for the 12-month period beginning January 1, 2010 will be $461. This premium is paid by enrollees age 65 and over who are not otherwise eligible for benefits under Medicare Part A (hereafter known as the “uninsured aged”) and by certain disabled individuals who have exhausted other entitlement. In some instances, certain of these individuals may qualify for a reduced premium of $254.  You can read more about the uninsured enrollee premium here.

Concurrently, CMS also announced that the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2010 under Medicare’s Hospital Insurance Program (Medicare Part A). For CY 2010, these amounts are as follows:

• The inpatient hospital deductible will be $1,100.
• The daily coinsurance amounts for CY 2010 will be:

ü      $275 for the 61st through 90th day of hospitalization in a benefit period;

ü      550 for lifetime reserve days; and

ü      137.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period.

The Social Security Act (the Act) requires the subtraction of an inpatient hospital deductible and certain coinsurance amounts from the amount otherwise payable under Medicare Part A.  The coinsurance and deductible amounts are calculated based on a statutory formula.  You can review the CMS announcement of these copayment and deductible amounts here.

CMS Renews Community Health Accreditation Program Authority To Accredit Hospices

The Centers for Medicare & Medicaid Services will continue to recognize the Community Health Accreditation Program (CHAP) as a national accreditation program for hospices seeking to participate in the Medicare or Medicaid programs for the period from November 20, 2009 though November 20, 2012. CMS announced its decision to conditionally approve the continuation of CHAP’s accreditation status with a 180-day probationary period on October 23, 2009 here.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.

©2009 Cynthia Marcotte Stamer.  All rights reserved

Senate Finance Committee Releases Statutory Language of America’s Healthy Future Act To Present To Full Senate

Americans finally have a chance to read the actual statutory language of the painfully negotiated package of proposed health care reforms that the Senate Finance Committee proposes for adoption.  The Senate Finance Committee leadership finally finished drafting has posted the 1506 page long text of the proposed statutory language of the health care reform provisions of the ”America’s Healthy Future Act” on its website here.

When the Senate Finance Committee vote passing the America’s Health Future Act, members of the Senate Finance Committee had not yet had the opportunity to review the actual statutory language to be proposed to implement the package of heatlh care reforms painfully hashed out in their committee.  As the actual statutory language had not been completed at the time a majority of the Democrats and one Republican Senator serving on the Senate Finance Committee voted to send the legislation to the the full Senate, the vote actually was taken based on a narative description of the intended reforms set forth in a revised draft of the “Chairman’s Mark” of the legislation.  Since that time Senate Finance Committee Chairman Max Baucus and other key Democrat Senators on the Senate Finance Committee have worked behind closed doors to prepare the actual statutory language to be presented to the full Senate.

As proposed, the America’s Healthy Future Act would require sweeping changes to the U.S. health care systems that if adopted will radically impact the roles and responsibilities of every patient, health care provider, health care payor, employer and other American.  Because of the potential implications on the way health care is financed, delivered and administered and the projections that the legislation will cost approximately $1 Trillion, all parties are urged to carefully review the complex and lengthy legislation to gain an understanding of the legislation and to act quickly to make any concerns known to elected leaders in Congress. 

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here and/or by participating in the SLP Health Care Risk Management & Operations Group on LinkedIn.  To unsubscribe, e-mail here.