Medicare and Medicaid


Provider Relief Fund Audits Coming
February 23, 2021 | Rivkin Rounds Staff | COVID-19 | Legislation and Public Policy | Medicare and Medicaid
A February 15 article in Part B News, “Provider Relief Fund audits coming; pick your method and keep good records,” discussed the Provider Relief Fund (PRF) authorized under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Rivkin Radler’s Bob Iseman was quoted in the article. Healthcare providers who received PRF funds were required …
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California Laboratory Settles FCA Claims Related to Genetic Testing
February 10, 2021 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
Exceltox Laboratories, LLC, a California diagnostic laboratory, is paying a $357,584 settlement to resolve allegations of False Claims Act (FCA) violations. Exceltox allegedly submitted or caused to be submitted claims for genetic tests to Medicare without valid physician oversight. In 2015, Exceltox engaged an independent contractor, Seth Rehfuss, who persuaded residents of low-income senior housing …
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Two Indicted in $100 Million Home Health Care Fraud Scheme
February 4, 2021 | Christopher J. Kutner | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on February 1 that an owner and operator of Arbor Homecare Services LLC and a nurse employed by the home health agency were indicted for their roles in a scheme to defraud MassHealth and Medicare of at least $100 million. The Massachusetts agency allegedly routinely billed the government …
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EHR Vendor to Pay $18.25 Million to Resolve Kickback Allegations
January 29, 2021 | Eric D. Fader | Electronic Health Records | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on January 28 that athenahealth Inc., a Massachusetts-based electronic health records (EHR) technology vendor, has agreed to pay $18.25 million to resolve allegations that it paid illegal kickbacks to generate sales of its EHR product, athenaClinicals. The settlement is the government’s latest reminder that marketing initiatives that are …
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CMS Clarifies RPM Reimbursement
January 28, 2021 | Eric D. Fader | Home Health | Legislation and Public Policy | Medical Devices and Wearables | Medicare and Medicaid | Telehealth
The Centers for Medicare & Medicaid Services (CMS) recently released corrections to its 2021 Physician Fee Schedule final rule that was published on December 28. Some of the corrections clarify reimbursement requirements for remote patient monitoring (RPM), which entails gathering and interpreting physiologic data from patients at home. The December 28 final rule had stated …
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HHS Rule Blocks Enforcement Actions Based Solely on Guidance
January 19, 2021 | Eric D. Fader | Legislation and Public Policy | Litigation | Medicare and Medicaid
On January 12, the U.S. Department of Health and Human Services (HHS) released a final rule on “Transparency and Fairness in Civil Administrative Enforcement Actions.” The rule, which was effective immediately, states that HHS can rely only on statutes and regulations in bringing civil enforcement actions. Standards set forth in agency guidance documents may not …
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NY Gov. Cuomo Proposes Expanded Telehealth Access
January 13, 2021 | Eric D. Fader | Behavioral Health | COVID-19 | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes | Telehealth
In his 2021 State of the State Address on January 10, New York Governor Andrew Cuomo announced legislation to expand access to telehealth. The proposals will adjust reimbursement incentives to encourage telehealth, relax or eliminate outdated regulatory restrictions on the delivery of telehealth services, and establish training programs for patients and providers and other programs …
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Substance Abuse Center and CEO in $6 Million Medicaid Fraud Settlement
January 6, 2021 | Margarita Christoforou | Behavioral Health | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
On December 21, New York State Attorney General Letitia James announced a $6 million settlement of a civil healthcare fraud lawsuit against A.R.E.B.A-Casriel, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (ACI) and its former owner and CEO, Steven Yohay. ACI will pay $3 million and Yohay will pay an additional $3 million personally …
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Medicare Physician Fee Schedule Expands Telehealth Coverage
December 11, 2020 | Eric D. Fader | Legislation and Public Policy | Medicare and Medicaid | Telehealth
The 2021 Physician Fee Schedule (PFS) final rule recently released by the Centers for Medicare & Medicaid Services (CMS) includes the addition of 60 new telehealth services that will be covered and reimbursed by Medicare. The new services will allow Medicare beneficiaries to have greater access to telehealth, with a particular focus on residents of …
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New AKS Safe Harbors Finalized
December 3, 2020 | Geoffrey R. Kaiser | Electronic Health Records | Fraud and Abuse | Hospitals | Legislation and Public Policy | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth
The Office of Inspector General, Department of Health and Human Services (OIG) has finalized new safe harbors and modifications of existing safe harbors under the federal Anti-Kickback Statute (AKS) to reflect a policy priority favoring a value-based health care system that “pays for health and outcomes” and that will “remove potential barriers to more effective …
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