Tag Archives: healthcare alert

Healthcare Alert: Tuomey Healthcare Systems ordered to pay nearly $278 million for Stark Law and False Claims Act violations

A United States District Court judge in South Carolina has ordered Tuomey Healthcare Systems (THS) to pay just shy of $278 million for entering into prohibited contractual relationships in violation of Stark Law and the False Claims Act (FCA). Click here to view the final order and opinion.

This case originated as a qui tam lawsuit filed by one of THS’ physicians, Dr. Michael Drakeford. Stark Law prohibits, among other things, a physician who has a “financial relationship” with an entity—such as a hospital—from making a “referral” to that hospital for the furnishing of certain “designated health services” for which payment otherwise may be made by the United States under the Medicare program.

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Healthcare Alert: Palmetto Medicare Part B policy update on prostate biopsy coding

On August 7, 2012, Palmetto GBA, a Medicare contractor, issued a policy update entitled “Prostate Biopsy Coding/Billing Guidelines.” This Palmetto policy references a National Correct Coding Initiative (NCCI) update that was published in January 2012, and appears to be the first instance of a Medicare contractor confirming its adoption of the January 2012 NCCI update.

The January 2012 NCCI update provides that:

“HCPCS Codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, or prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT Code 88305 be utilized only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT Code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens.” 

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