Medicare and Medicaid


Zocdoc Fees Get Anti-Kickback Approval
September 18, 2019 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
The online appointment booking service Zocdoc has received a favorable Advisory Opinion from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) confirming that Zocdoc’s new per-click or per-booking fee model does not violate the federal Anti-Kickback Statute (AKS). Without AKS concerns, Zocdoc may now allow Medicare, Medicaid, and other federal …
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Kaiser to Present at PLI Life Sciences Program
September 17, 2019 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | FDA | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On October 10, Rivkin Radler’s Jeff Kaiser will be a panelist at the Practising Law Institute (PLI) program, “Life Sciences 2019: Navigating Legal Challenges in the Drug and Device Industries.” Jeff will speak on “Enforcement Trends Impacting the Drug and Device Industries,” including developments under the False Claims Act, federal Anti-Kickback Statute, off-label promotion, and …
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FCA Ruling: Proof of Falsity Needed to Show Fraud
September 16, 2019 | Geoffrey R. Kaiser | False Claims Act | Fraud and Abuse | Hospitals | Legislation and Public Policy | Litigation | Medicare and Medicaid
Last week, the 11th Circuit Court of Appeals handed down its long-awaited decision in United States v. AseraCare, Inc. The case, brought under the False Claims Act (FCA) and argued way back in March 2017, alleged that AseraCare, a for-profit multi-state hospice chain, had submitted false claims to the Medicare program for patients who were …
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New Rule Augments CMS’s Fraud-Fighting Powers
September 13, 2019 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On September 5, the Centers for Medicare & Medicaid Services (CMS) announced the issuance of a final rule that will allow the agency to deny or revoke a healthcare provider’s or supplier’s federal program enrollment if it is “affiliated” with another previously revoked organization. The rule had originally been proposed more than three years ago. …
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Kickback Charges Lead to False Claims Act Case
August 27, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The Manhattan U.S. Attorney’s Office recently announced that the U.S. Department of Justice has intervened in a whistleblower suit against Life Spine Inc., an Illinois-based manufacturer of spinal implants, devices and equipment. The lawsuit, which seeks damages and civil penalties under the False Claims Act (FCA), claims that Life Spine paid millions of dollars in …
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CMS Adds Health Plan Ratings to ACA Exchanges
August 20, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Centers for Medicare & Medicaid Services (CMS) announced on August 15 that health plans offered on health insurance exchanges will be ranked using a five-star quality rating system for the 2020 plan year open enrollment period that begins on November 1, 2019. The ratings will appear on both state-based exchanges and the federal exchange, …
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Medicare Physician Fee Schedule for 2020 Includes Telehealth Changes
August 15, 2019 | Eric D. Fader | Home Health | Legislation and Public Policy | Medicare and Medicaid | Telehealth
On July 29, the Center for Medicare and Medicaid Services (CMS) released its proposed revisions to the Medicare Physician Fee Schedule for 2020. The Proposed Rule was published in the Federal Register on August 14. CMS proposed to add three new codes for treatment of opioid use disorder to the list of services that are …
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Genetic Testing Scam Targets Medicare Beneficiaries
August 14, 2019 | Eric D. Fader | Fraud and Abuse | Medicare and Medicaid
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Fraud Alert on August 13 regarding a genetic testing scam targeting Medicare beneficiaries. The scammers will offer a “free” screening for genetic testing but then submit a claim to Medicare, which will likely deny the claim as medically unnecessary. The …
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NY IPA Focuses on Social Determinants of Health
August 13, 2019 | Cassandra Rivais DiNova | Home Health | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
On August 6, health insurer MVP Health Care announced an affiliation with Alliance for Better Health to address so-called social determinants of health in the Albany, New York area. The newly formed independent practice association (IPA), Healthy Alliance Independent Practice Association, is one of the first IPAs in the U.S. to focus exclusively on social …
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OIG Audit Reveals NY Medicaid Eligibility Errors
July 25, 2019 | Margarita Christoforou | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid
Based on a recent audit of payments under New York’s Medicaid program, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) estimated in a report that the state made hundreds of millions of dollars in payments to ineligible or “potentially ineligible” beneficiaries. The audit examined payments to “non-newly eligible” beneficiaries, meaning …
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