Showing 73 posts in Medicare/Medicaid.
HHS OIG Report Identifies Non-Compliance in Hospice Documentation
Hospice care is intended to help terminally ill beneficiaries continue living with minimal disruptions and to provide support for a beneficiary’s family and caregivers. In a recent report, the Department of Health and Human Services Office of Inspector General (OIG) found that hospices are not always meeting two key coverage requirements for the Medicare hospice benefit: (1) that beneficiaries sign an election statement and (2) that a physician certifies that the beneficiary is terminally ill. The purpose of these requirements is, among other things, to properly inform beneficiaries of the implications of hospice care and to prevent Medicare fraud. Read More ›
Categories: Medicare/Medicaid
Share
CMS Announces New Conditions of Participation for Long-Term Care Facilities
Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.
LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three. Read More ›
Categories: Compliance, Medicare/Medicaid, News & Events, Pharmacy, Providers
DOJ Starts Cracking Down on Individual Health Care Executives for False Claims Act and Stark Law Violations Committed by Their Companies
Healthcare executives and physicians take note: The Department of Justice is now cracking down on individuals, and not just companies, for False Claims Act, Stark law, and anti-kickback statute violations. Read More ›
Categories: Hospitals, Medicare/Medicaid, News & Events, Physicians
CMS Final Rule on Reporting and Returning of Overpayments Has Potentially Only an Eight-Month Safe Harbor
The Final Rule on Reporting and Returning of Overpayments (“Final Rule”), which became effective on March 14, 2016, requires Medicare providers to report and return Medicare overpayments by the later of (i) 60 days after the date on which the overpayment was identified, or (ii) the date on which any corresponding cost report was due. This 60-day deadline for returning overpayments is suspended when any of the following occurs: Read More ›
Categories: Billing/Payment, Compliance, Medicare/Medicaid
Quality versus Quantity Transformation in Healthcare Picks Up Pace as CMS Issues New Rules
The march to transform Medicare from a quantity-based to a value-based system continues unabated - and the pace is quickening. Over the past several months, the Centers for Medicare & Medicaid Services (“CMS”) issued several final rules to update certain Medicare reimbursement rates and quality reporting requirements that impact vast numbers of healthcare providers. Read More ›
Categories: Billing/Payment, Medicare/Medicaid, Providers
Nursing Homes Should Review Privacy Policies in Light of Recent CMS Guidance
A recent Memorandum issued by the Centers for Medicare & Medicaid Services ("CMS") to state survey agency directors (the "Memorandum") discusses a nursing home's responsibility to protect residents' privacy, particularly with regard to social media. The Memorandum was issued following a series of media reports documenting the inappropriate posting of residents' photographs on social media by nursing home staff. Read More ›
Categories: HIPAA, Medicare/Medicaid, Privacy
CMS Expands Temporary Home Health Agency Enrollment Moratorium to all of Michigan
The Centers for Medicare & Medicaid Services ("CMS") recently announced the statewide expansion of its temporary moratorium on the Medicare enrollment of new home health agencies ("HHAs"), subunits, and branch locations in Michigan. As a result of the moratorium expansion, effective as of July 29, 2016, new HHAs in Michigan are precluded from enrolling in Medicare until the moratorium is lifted. The temporary moratorium also precludes the Medicare enrollment of new HHAs in Florida, Illinois, and Texas. Read More ›
Categories: Medicare/Medicaid, Providers
CMS Issues Proposed Provider-Based Status Rules
On July 6, 2016, the Centers for Medicare & Medicaid Services ("CMS") released the 2017 Outpatient Prospective Payment System ("OPPS") Proposed Rule (the "Proposed Rule"). The Proposed Rule explains how CMS plans to implement Section 603 of the Bipartisan Budget Act of 2015 ("Section 603"), which established a new site neutral payment policy for certain off-campus hospital outpatient departments.
Section 603 provides that, as of January 1, 2017, certain items and services provided by off-campus hospital outpatient departments will no longer be reimbursed under the more favorable OPPS, and will instead be paid under another "applicable payment system." Read More ›
Categories: Billing/Payment, Medicare/Medicaid, News & Events, Physicians, Providers
District Court Awards Summary Judgment to AseraCare in $200 Million Hospice False Claims Act Case
On March 31, 2016, the United States District Court for the Northern District of Alabama granted summary judgment for AseraCare in one of the largest False Claims Act (FCA) lawsuits against a hospice provider. In this whistleblower case, the government sought over $200 million, alleging that defendant AseraCare overbilled Medicare for hospice services by falsely certifying that patients were eligible for hospice care.
The litigation began when six AseraCare employees in Alabama, Wisconsin and Georgia (the "relators") filed whistleblower cases under the FCA. The employees alleged that AseraCare knowingly submitted false claims to Medicare by falsely certifying that patients met the Medicare eligibility requirements for the hospice benefit. In order to be eligible for the Medicare hospice benefit, a patient's physician must certify that "the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course." 42 C.F.R. § 418.22(b)(1). The Department of Justice (DOJ) intervened in January 2012. Read More ›
Categories: Audits, Billing/Payment, Medicare/Medicaid, Providers
Michigan Health Insurance Claims Assessment Act back for Reconsideration
The Michigan Health Insurance Claims Assessment Act is back for reconsideration before the United States Court of Appeals for the Sixth Circuit. The act imposes a tax on paid health care claims that is used to fund the state share of Michigan’s Medicaid program. The act had been upheld by the federal appeals court in 2014 against an ERISA preemption challenge brought by an organization representing self-insured group health plans and third-party administrators.
The Supreme Court recently remanded the case to the federal court of appeals for reconsideration in light of a decision holding that a Vermont all-payers claim database statute interfered with the uniform administration of ERISA plans and was therefore preempted. Read More ›
Categories: Medicare/Medicaid, Tax
Categories
- Audits
- Health Care Reform
- Hospitals
- Patents
- Insurance
- Legislative Updates
- Labor Relations
- Regulations
- Billing/Payment
- Medicaid Planning
- Criminal
- Providers
- COVID-19 and Workers' Compensation
- Contracts
- HITECH Act
- Lawsuit
- Did you Know?
- Electronic Health Records
- Pharmacy
- 6th Circuit Court of Appeals
- Long-Term Care
- Physicians
- Privacy
- Regulatory
- Tax
- Cybersecurity
- Accountable Care Organizations
- Compliance
- Licensing
- Digital Assets
- Medicare
- Health Insurance Exchange
- HIPAA
- Employee Benefits
- Affordable Care Act
- Medicare/Medicaid
- Technology
- Fraud & Abuse
- Retirement
- News
- Hospice
- News & Events
- Department of Labor
- Alerts and Updates
- Employment
- Workers' Compensation
Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.