All area healthcare managers and physicians are invited to attend. Space is limited, so please RSVP for the May 13th meeting by emailing info@doctorslawyer.com or call us at 704-643-9076 today! Make sure to invite colleagues or anyone you think might be interested in attending.

The Healthcare Roundtables are held from 9:00 – 10:00 a.m. at our office located at 6525 Morrison Blvd., Suite 400, in the Southpark area of Charlotte, NC. Parking is free and refreshments will be served.

All area healthcare managers and physicians are invited to attend. Space is limited so please RSVP by emailing  info@doctorslawyer.com or call us at 704-643-9076 today!

Also, don’t forget to mark you calendars for the Roundtables on April 8th and May 13th. Topics to be announced and reminder emails will be sent prior to each meeting.

The healthcare roundtables are held from 9:00 – 10:00 a.m. at our offices located at 6525 Morrison Blvd., Suite 400, in the Southpark area of Charlotte, NC. Parking is free and refreshments will be served.

On October 26, 2009, NCMS, as part of a coalition of physician organizations, sent a letter to the Insurance Commissioner outlining major problems with the BCBSNC contract addendum. BCBSNC subsequently filed a revised addendum with the Insurance Commissioner in an effort to address some of these concerns. While the revised addendum contained a few improvements, it still fell short of the requirements of SB877. On December 18^th, NCMS sent a second letter to the Insurance Commissioner outlining concerns with the revised addendum. Insurance Commissioner Wayne Goodwin subsequently denied approval of the BCBSNC revised addendum.

The settlement agreement that resolved the class action against Blue Plans and a number of state medical associations (including NCMS) contains provisions that require BCBSNC to comply with state law. Based in part on our belief that the addendum distributed by BCBSNC on October 1, 2009 is inconsistent with SB877, the NCMS has filed a compliance dispute under the settlement agreement.  The compliance dispute alleges timeframe violations of notice requirements, overreaching exceptions to notice requirements for fee schedule changes, failure to conform to relevant provisions of the settlement agreement, and failure to follow state law.  We will keep our members apprised of developments in this area.

The expansion marks the fifth, sixth, and seventh phases of a targeted criminal, civil, and administrative effort against individuals and healthcare companies that fraudulently bill the Medicare program, the agencies said in a press release.

The joint Department of Justice (DOJ)-HHS Medicare Fraud Strike Force is a multi-agency team designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing, the release said.

Since the inception of Strike Force operations in Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), Houston (Phase Four), and Brooklyn (Phase Five), the Strike Force has obtained indictments for more than 460 individuals and organizations that together have falsely billed the Medicare program for over $1 billion dollars, according to the release.

Sebelius and Breuer also announced that 30 people have been charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims pursuant to Strike Force operations in Miami, Detroit, and Brooklyn.

The indicted individuals are accused of various Medicare fraud crimes, including conspiracy to defraud the Medicare program, conspiracy to launder money, money laundering, criminal false claims, making false statements, and receiving kickbacks, according to the agencies.

View the HHS/DOJ press release

For a link to the full document as well as a memo from the Inspector General: http://www.oig.hhs.gov/publications/challenges/files/TM_Challenges09.pdf

The OIG reported savings and expected recoveries of $20.97 billion for all of FY 2009. Specifically, OIG’s $20.97 billion in savings and expected recoveries includes $16.48 billion in implemented recommendations to put funds to better use, $4 billion in investigative receivables, and $492 million in audit receivables.

“We continue to make significant progress in our fight against fraud, waste, and abuse in HHS programs, particularly Medicaid and Medicare,” said Inspector General Daniel R. Levinson. “We’re doing this by leveraging our audit, legal, evaluation, and investigative tools, as well as employing the latest in data analysis technology. But the results we’ve achieved are due primarily to the hard work of our professional staff and effective collaboration with our government partners. We will remain aggressive in our mission to protect the integrity of these vital programs.”

For full report visit http://www.oig.hhs.gov/publications/docs/semiannual/2009/semiannual_fall2009.pdf

To view press release go to http://www.oig.hhs.gov/publications/docs/press/2009/SemiannualFall2009PressRelease.pdf

For a period of time that was not been clearly defined the name, address, email, and taxpayer ID number (which in some cases is the physician’s Social Security number) for an undetermined number of NC physicians could be viewed on the MedSolutions website. Access to this information apparently was not limited to physicians or physician staff. Based on the information available at the time of the posting, any person with an email address could enter physician names and view the information.

The NCMS is continuing to research the scope of the breach through MedSolutions and the NC Division of Medical Assistance. For now, all physicians who have identified themselves to MedSolutions should be aware that their personal information may have been accessible through the MedSolutions website. Appropriate steps should be taken to protect against fraudulent use of the information. NCMS says it has been working aggressively to determine the scope of the breach and ensure that appropriate remedial steps have been taken.

The PAI joined with representatives from the Connecticut State Medical Society, the AMA and the Connecticut Health Project to express deep-seated concerns about the impact the proposed acquisition will have on more than 220,000 Connecticut patients. Review a transcription of Mr. Seligson’s Testimony (PDF) or news release about the hearing (PDF).