November 18th, 2024
Medicare Decreases Physician Fee Schedule by 2.93%
Michael Cassidy of Tucker Arensberg, P.C. reports that the finalized Medicare Physician Fee Schedule for the 2025 calendar year was released on November 1st. The Medicare Conversion Factor for the Physician Fee Schedule has been reduced by 2.93%, from $33.29 in 2024 to $32.35 in 2025. Below is a link to the Press Release outlining all the changes to Medicare, along with the link to the complete Final Rule.
DOJ Press Release: Fraudulent Marketing Scheme
Jeffrey Baird of Brown & Fortunato discusses that the Baby Boomer and Millennial generations are aging, creating increased demand for healthcare products, especially durable medical equipment (DME), such as soft goods (wound care, incontinence products, etc.). Fraudulent activities, such as kickbacks for medically unnecessary DME, have led to legal scrutiny. A recent case involved a marketer pleading guilty to healthcare fraud, causing Medicare losses of $4.2 million. DME suppliers must ensure that marketing arrangements comply with anti-kickback laws to avoid legal risks and penalties.
Expectations for Healthcare Antitrust Policy in New Presidential Administration
Lucas Smith of Bass, Berry & Sims , shared his expectations for antitrust policy in the healthcare sector under the incoming presidential administration. Contrary to some views, he anticipates continued enforcement of antitrust laws regarding healthcare mergers. "I don’t think the stereotype is true that they won’t enforce merger laws vigorously," he stated, expecting a "meat and potatoes" approach similar to the second Trump administration. However, he also predicts the new administration will be less inclined to explore novel legal theories on vertical integration transactions, like insurer acquisitions of pharmacy benefit managers.
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Best Lawyers Ranks HLB as a 2025 Top National Health Care Law Firm
Best Lawyers has released its 2025 "Best Law Firms" rankings, with Hooper, Lundy & Bookman, P.C. earning a National Tier 1 ranking for Health Care Law. The firm also received Metropolitan Tier 1 rankings for Health Care Law in Boston, Los Angeles, San Diego (including Litigation), and Washington, D.C. Additionally, HLB was ranked Metropolitan Tier 2 for Criminal Defense: White Collar in Boston and for Administrative/Regulatory Law in Los Angeles and San Francisco.
UC Health Agrees to Pay $23M to Resolve Allegations of Fraudulent Billing for Emergency Department Visits
The U.S. Department of Justice’s Office of Public Affairs reported that the University of Colorado Health (UCHealth) has agreed to pay $23 million to settle allegations of violating the False Claims Act by improperly coding emergency department visits for payment from Medicare and TRICARE. From November 2017 to March 2021, UC Health allegedly used an automated system that incorrectly assigned the highest billing code (CPT 99285) based on vital sign checks rather than the actual medical resources used, leading to inflated claims. A whistleblower will receive $3.91 million from the settlement. The case highlights ongoing efforts to combat healthcare fraud.
Navigating Compliance: Key Requirements for Labs and Pathology Providers
Join McDonald Hopkins LLC and Lighthouse Lab Services for a webinar on navigating compliance challenges in the healthcare industry for laboratory and pathology providers. Experts will discuss CLIA pitfalls, remote pathology interpretation requirements, and strategies for preparing and defending against billing audits. Presenters include Emily Johnson , Jane Pine Wood , Lori Millner, PhD, NRCC and Dyana Williams , who will provide valuable insights on staying compliant and competitive in a rapidly evolving landscape.