Miller Health Law Group Bulletin: New Health Care Reform Compliance Deadlines

National Health Care Reform

The Patient Protection and Affordable Care Act (“PPACA”) and the Health Care and Education Reconciliation Act of 2010 are now the law of the land. While many of the provisions of this landmark legislation will be implemented over the next few years, there are several aspects of the new law that may require your immediate attention.

Refund of Overpayments. Pursuant to Section 6402 of PPACA, physicians, hospitals, suppliers and others are now required to (1) report and refund Medicare and Medicaid overpayments within 60 days of the date the overpayment has been “identified,” and (2) provide written notice of the reason for the overpayment. Failure to comply can result in a violation of the False Claims Act and subject violators to civil monetary penalties and exclusion from the Medicare and Medicaid programs.

In-Office Imaging Services. Section 6003 of PPACA makes an important change to the in-office ancillary services (IOAS) exception to the Stark law. Physicians and medical groups which have relied upon the IOAS exception in order to lawfully provide MR, CT and PET to their Medicare patients must now meet two additional requirements to qualify for the IOAS exception with respect to these services: (1) the referring physician must inform the patient, in writing, at the time of the referral that the patient may obtain these services from someone else, and (2) provide the patient with a written list of suppliers who furnish the service in the area in which the patient resides.

There is some question as to whether the notice requirement is effective immediately. Until there is further clarification of the issue, we recommend that physicians and medical groups give the notice because failure to do so (assuming the requirement is in effect) will mean that any claims submitted to Medicare for these imaging services will be in violation of the Stark law.

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