Publications for Gary J. McRay
In October and November of 1992, an insurance company called AXA Equitable Life Insurance Company issued a health insurance policy that provided coverage for certain individuals. The U.S. Department of Treasury’s Office of Foreign Assets Control (“OFAC”), later in 2009, added parties to the list of Specially Designated Nationals and Blocked Persons (the “SDN List”).
One of the main concerns that healthcare providers have regarding clinical integration is whether there is an issue with anti-trust law.
Tuomey Healthcare System faces up to $237 million in fines and penalties after a jury found it liable for submitting $39 million worth of claims to Medicare in violation of both the Stark Law and the False Claims Act.
Many hospitals and groups of physicians are forming Accountable Care Organizations to cover Medicare fee for service beneficiaries under the Medicare Shared Savings Program. What issues must new ACOs keep in mind in its proceeding to qualify for the MSSP program? This article discusses that question.
As part of the 2010 Healthcare Reform Act, Code Section 501(r) of the Internal Revenue Code was added to provide that a hospital would lose its tax exemption unless the hospital meets five requirements.
One costly problem for Medicaid and Medicare is the inordinate amount of money spent on individuals who are dually eligible for both Medicare and Medicaid. Michigan introduced its solution to this problem in the form of its proposal to "Integrate Care for People Who Are Medicare - Medicaid Eligible ("MMEs")".
On October 20, 2011, the IRS issued a new Fact Sheet that provided additional information for exempt organizations on how their participation in the MSSP through an ACO would be treated by the IRS.
Michigan's legislature, like 15 other state legislatures, has proposed legislation to create its own insurance exchange.
Hospitals are required to create a community health needs assessment in order to be recognized, or continue being recognized, as a 501(c)(3) entity.
The federal government, through the Health Information Technology for Economic and Clinical Health Act (“HITECH”) is pushing physicians and other health care professionals towards EHR by offering financial incentives and eventually imposing financial penalties.
This article is a follow-up to an earlier article in April where we discussed various issues facing three likely entities that might take the lead in creating an ACO.
The Federal Trade Commission and the Department of Justice's response to Accountable Care Organizations is not surprising: more regulation.
Many are concerned that current fraud and abuse laws would prevent the development of ACOs and their benefits of higher quality medicine and lower costs.
When Section 3022 of the Patient Protection and Affordable Care Act was passed it became clear that in order to establish a Medicare Shared Savings Program, it would take health care practitioners to combine in networks, partnerships or joint ventures with tax-exempt hospitals or health systems to obtain the coverage necessary to achieve the government's goals: higher quality and health care savings.
While the Patient Protection and Affordable Care Act may be a year old, one of the provisions that may have the greatest impact on the health care industry has received hardly any attention from the media or lawmakers.
Early retirees are individuals age 55 and older who are enrolled in a certified employment-based plan, and not eligible for coverage under Medicare.
Since 1969, hospitals have been able to claim an exemption from federal income taxes under § 501(c)(3) of the Internal Revenue Code ("Code") based upon meeting the "community benefit" standard articulated by Revenue Ruling 69-545.
Most exempt organizations must file an annual return (Form 990, Form 990-PF or Form 990-EZ) or an annual electronic notice (Form 990-N) depending on the organization's gross receipts and total assets.
Medicare oversees a variety of payment systems and a network of contractors that process over 1.2 billion claims each year.
Advisory Opinion 08-15, issued by the Office of Inspector General...
The following 16 conditions have to be met for the hospital and the physicians to fit within the new Stark gainsharing exception:
Ever since the Supreme Court’s decision in Arizona v Maricopa County Medical Society, 457 US 332 (1982), it has been clear that price fixing by competitors is a per se violation of the federal antitrust law.
Since the Whistleblower Office was created in December 2006, the IRS has reported that it has received about 80 claims, half of which were submitted in just the last two and a half months of 2007.
On December 28, 2007, the Office of Inspector General ("OIG") issued Advisory Opinion No. 07 21 involving a group of cardiac surgeons and Advisory Opinion No. 07 22 involving a group of anesthesiologists.