Recent Publications - Christopher J. Kutner


Kutner quoted in Part B News
February 6, 2017 | Health Services
Christopher J. Kutner was quoted in a Part B News article entitled, “Beyond QPP: Check Your Readiness for Insurer-Based Physician Incentive Programs.” Regarding non-federal physician incentive programs, Chris said they are about shifting to value-based payment options, so be sure you’re in a position to take it on. “Even without downside risk, you have to think about …
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New Bill Proposed in Senate to Regulate Upper Endoscopic Procedures
May 26, 2016 | Health Services
A new bill has been introduced in the New York Senate that would require the Department of Health to promulgate rules governing all upper endoscopic procedures, including all examinations of vocal cords, esophagus, and stomach that utilize a flexible endoscopic instrument. Approximately ten million upper endoscopic procedures are performed in the United States each year. …
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OIG Fraud Alert: Physician-Owned Medical Device Manufacturers
January 26, 2016 | Health Services
Recently, the U.S. Department of Health and Human Services Office of the Inspector General (DHHS-OIG) issued a fraud alert.  The alert concerned physician owned distributors (PODs) that derive revenue from selling, or arranging for the sale of implantable medical devices ordered by their physician-owners for use on their own patients at hospitals or ambulatory surgical …
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OIG Work Plan for 2016
January 1, 2016 | Health Services
The Department of Health and Human Services, Office of Inspector General (“OIG”) has released its Work Plan for Fiscal Year 2016 (“Plan”). The Plan summarizes new and ongoing audits, investigations and evaluations that OIG will prioritize in the upcoming year. While many of the areas of focus addressed in the Plan are similar to those …
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Health Republic Insurance of New York Announces that Coverage will End on November 30, 2015
November 23, 2015 | Health Services
Health Republic Insurance of New York (“Health Republic”) has announced that it will not offer coverage after November 30, 2015 leaving over 200,000 of its customers scrambling to find new health insurance. Health Republic is one of twenty-three non-profit insurance plans that were created under the Affordable Care Act to increase competition in the insurance …
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OIG Releases Work Plan for 2016
November 23, 2015
The Department of Health and Human Services, Office of Inspector General (“OIG”) has recently released its Work Plan for Fiscal Year 2016 (“Plan”). The Plan summarizes new and ongoing audits, investigations and evaluations that OIG will prioritize in the upcoming year. While many of the areas of focus addressed in the Plan are similar to …
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Compliance Season: Assessing Provider Readiness for OMIG Certification
November 3, 2015 | Health Services
Medical, health home, mental health, and other providers licensed by the New York State Department of Health, Office of Mental Health or other governmental agency, and any providers ordering, providing, billing or claiming at least $500,000 from Medicaid in a consecutive twelve month period, are required to have an effective compliance program. Those providers must …
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ACA Grace Period Places Burden on Providers and Hospitals
January 26, 2015 | Health Services
The Patient Protection and Affordable Care Act (ACA) was enacted to enable patients to make informed choices regarding their healthcare by providing stability and flexibility in insurance coverage.  To facilitate the implementation of stable coverage, the ACA requires that qualified health plans (QHPs) provide a grace period of three consecutive months if an enrollee, receiving …
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Executive Budget Proposes Changes to Out-of-Network Billing
February 10, 2014 | Health Services
Governor Cuomo’s budget contains many proposed changes to the Public Health Law (some of which are discussed here), but another set of significant changes that will affect providers and patients is contained in the Insurance Law. The Transportation, Economic Development, and Environmental Conservation (“TED”) Article VII bill contains proposed legislative changes that would alter the …
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The Growing Role of Telehealth and Possible Pitfalls for Providers
February 10, 2014 | Health Services
Long wait times and difficulty for a patient to get convenient doctor’s appointments have long been issues for patients seeking medical treatment.  The expansion of individuals with health insurance due to the Affordable Care Act will cause the issue to grow as more individuals have access to health care services they previously did not.  With …
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Program of All-Inclusive Care for the Elderly (“PACE”)
November 30, 2013 | Health Services
I.  Introduction and Background of PACE The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive long term services and support to Medicaid and Medicare enrollees.  A multi-disciplinary team of health professionals provides individuals with coordinated care.  For most participants, the comprehensive service package enables them to receive care at home rather than receive …
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Telehealth and Newly Approved CPT Codes
November 30, 2013 | Health Services
Medicare’s 2014 Physician Fee Schedule includes several new Telehealth services and service regions that will be reimbursed under the Medicare Program beginning in 2014.  The new Fee Schedule will expand the geographic areas Medicare will cover Telehealth, expanding into the “fringes of metropolitan areas.”  The American Telemedicine Association has stated this will enable providers to …
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CMS and OIG Propose Changes to the Electronic Health Record Services Stark Exception and Anti-Kickback Safe Harbor
May 31, 2013
Recently, the Center for Medicare & Medicaid Services (“CMS”) and the Health and Human Services Office of Inspector General (“OIG”) published proposed rules that if enacted would modify certain aspects of the electronic health records Stark Law exception and Anti-Kickback safe harbor by extending its sunset date.[1]   The proposed rules would extend the December 31, …
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The Omnibus Rule: Major Changes
May 31, 2013 | Health Services
On January 17, 2013, the U.S. Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) released the final Omnibus Rule (“Omnibus Rule” or “Final Rule”) amending the HIPAA Privacy, Security, Breach Notification and Enforcement Rules.  As described by HHS OCR Director Leon Rodriguez, “[t]his final omnibus rule marks the most sweeping changes …
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The Affordable Care Act and Health Insurance Exchanges
May 31, 2013 | Health Services
The Affordable Care Act (“ACA”) provides for the establishment of State or regional health insurance exchanges where individuals can shop, compare and purchase medical care coverage beginning the last quarter of this year for coverage effective January 1, 2014.  In connection with establishing a state-based health insurance exchange by October 1, 2013, there are so …
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Office of Medicaid Inspector General Releases New Work Plan
May 31, 2013
The New York State Office of the Medicaid Inspector General (“OMIG”) recently released its Work Plan for fiscal year 2013-2014 (the “Work Plan”). The Work Plan describes activities that OMIG plans to initiate or continue during 2013 and 2014, including its outline of areas of fraud that the agency will target in the new fiscal …
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