MEDICAID PROVIDERS: DOES YOUR ORGANIZATION RECEIVE 5 MILLION OR MORE IN MEDICAID?
If so, as of January 1, 2007, you must educate all of your employees, agents and contractors on the False Claims Act, Qui Tam provisions, whistleblower rights and relevant state false claims act laws. The law requires you to have detailed and clear written policies describing the state and federal laws, and procedures for detecting and preventing fraud, waste and abuse. The updated policies should be distributed to all employees, agents and contractors. In addition, the law specifically requires your employee handbooks to include a specific discussion of the laws, the rights of employees to be protected as whistleblowers, and the entity's policies and procedures for detecting and preventing fraud, waste, and abuse.

DOCTORS: IS THAT RADIOLOGY EQUIPMENT STILL A GOOD INVESTMENT?
Over the past several years, physician ownership of nuclear radiology equipment such as positron emission tomography (PET Scans) has skyrocketed. One reason for this was a loop hole in the federal Stark II laws that allowed physicians to own such equipment and refer patients for use of the equipment without needing to meet one of the federal Stark II exceptions. A group of physicians who otherwise were not part of the same group practice, could pool together funds, establish an imaging center for nuclear radiology and not worry about meeting a Stark II exception. This was possible because Stark II applies only to certain "designated health services" and "radiology services" although a listed DHS are further defined based on specific CPT codes. PET Scans and other similar nuclear radiology services were not considered DHS. So the financial relationship did not need to meet one of the exceptions under Stark II. Starting January 1, 2007, the DHS radiology CPT codes are being expanded to include certain nuclear radiology and other services including PET scans. This means that everyone should be revisiting their analysis under Stark II to make certain their arrangements fit within one or more of the relevant exceptions.