Medicare and Medicaid


Proposed Physician Fee Schedule Adds Coverage for Remote Therapeutic Monitoring
July 21, 2021 | Eric D. Fader | Electronic Health Records | Home Health | Legislation and Public Policy | Medical Devices and Wearables | Medicare and Medicaid | Telehealth
The proposed 2022 Medicare Physician Fee Schedule released on July 13 by the Centers for Medicare & Medicaid Services (CMS) includes a new category of CPT codes for “remote therapeutic monitoring” (RTM). The new codes are in addition to the set of codes introduced in 2019 for remote physiological monitoring, usually called remote patient monitoring …
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Proposed Physician Fee Schedule Includes Expanded Telehealth Reimbursement
July 15, 2021 | Eric D. Fader | Behavioral Health | Legislation and Public Policy | Medicare and Medicaid | Telehealth
The proposed 2022 Medicare Physician Fee Schedule, released on July 13 by the Centers for Medicare & Medicaid Services (CMS), includes expanded reimbursement for behavioral health services delivered by telehealth, including reimbursing providers for audio-only telephone calls. The proposed expansion would allow Medicare beneficiaries with mental health or substance abuse disorders to receive diagnosis, evaluation …
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Compounding the Fraud: Questionable Billing by Pharmacies
July 6, 2021 | Rivkin Rounds Staff | FDA | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals
Rivkin Radler partners Evan Krinick and Michael Sirignano authored an article, “Compounding the Fraud: Questionable Billing by Pharmacies,” in the July 6 issue of the New York Law Journal. The article discussed the U.S. Department of Justice’s continued concern over fraudulent claims for reimbursement to federal healthcare programs for compounded prescription drugs. …
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The Impact of Stark Law and AKS Changes on Compliance in Real Estate Transactions
July 6, 2021 | Rivkin Rounds Staff | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On Wednesday, July 7, in the next installment of the firm’s Healthcare Compliance Lunch & Learn series, Rivkin Radler attorneys Benjamin P. Malerba and Ada Janocinska will discuss key compliance considerations under the federal Anti-Kickback Statute (AKS) and Stark Law as they relate to real estate transactions.  The presentation will provide: • An overview of …
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OIG: Hospitals Need to Improve Oversight of Cybersecurity for Networked Medical Devices
June 29, 2021 | Eric D. Fader | Cybersecurity | Electronic Health Records | Hospitals | Legislation and Public Policy | Medical Devices and Wearables | Medicare and Medicaid
On June 23, the Department of Health and Human Services Office of Inspector General (OIG) posted on its website an Issue Brief entitled “Medicare Lacks Consistent Oversight of Cybersecurity for Networked Medical Devices in Hospitals.” According to the OIG, the Centers for Medicare & Medicaid Services should amend interpretative guidelines or other nonbinding guidelines, or …
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Acting Medicaid IG Frank Walsh Shares Agency’s Priorities
June 2, 2021 | Robert Hussar | Ashley (Osadon) Algazi | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On May 13, Rivkin Radler partner, and former OMIG First Deputy, Robert Hussar kicked off Rivkin Radler’s new Healthcare Compliance Lunch and Learn Series. He interviewed Frank T. Walsh, Jr., who offered his first public comments since assuming his role as Acting NYS Medicaid Inspector General (pending State Senate confirmation). Mr. Walsh provided health care …
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How to Avoid False Claims Act Violations
June 1, 2021 | Rivkin Rounds Staff | COVID-19 | Employer/Employee | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid | Telehealth
On June 10, Rivkin Radler partner Bob Iseman will discuss False Claims Act (FCA) compliance in the next installment of the firm’s Healthcare Compliance Lunch & Learn series, “How to avoid False Claims Act violations.” The webinar registration page is here. The FCA applies to any person or entity doing business with the federal government. Every …
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DOJ Announces COVID-19 Fraud Takedown
May 27, 2021 | Eric D. Fader | COVID-19 | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid | Telehealth
On May 26, the U.S. Department of Justice (DOJ) announced criminal charges against 14 defendants in six states for participation in healthcare fraud schemes related to the COVID-19 pandemic. The coordinated takedown involved fraudulent claims for laboratory testing, telemedicine fraud, pharmacy fraud, payment of kickbacks for referrals, and alleged misappropriation of COVID-19 Provider Relief Fund …
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EHR Company in $3.8M Kickback Settlement
May 13, 2021 | Eric D. Fader | Electronic Health Records | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Department of Justice recently announced that CareCloud Health, a Florida-based developer of electronic health records software, agreed to pay $3.8 million to resolve a whistleblower’s allegations that it paid illegal kickbacks to generate sales of its products. CareCloud’s marketing referral program called the “Champions Program” allegedly violated the federal Anti-Kickback Statute (AKS) and …
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Insurance Fraud Scheme Lands Chiropractor in Prison
April 16, 2021 | Margarita Christoforou | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on April 13 that James Spina, a licensed chiropractor and the unlawful operator of Dolson Avenue Medical, P.C. (DAM), was sentenced to nine years in prison and three years of post-release supervision. DAM, a multi-disciplinary medical practice in Middletown, New York, purported to provide a variety of pain …
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