Medicare and Medicaid


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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Home Health Agency Settles Kickback/Stark Allegations
November 30, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
The U.S. Department of Justice announced on November 20 that Doctor’s Choice Home Care, Inc. agreed to pay $3,856,000 to resolve allegations that the agency paid illegal kickbacks to physicians for referring patients. The agency will pay an additional $675,000 to resolve separate allegations that its employees pressured clinical personnel to increase the number of …
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Final Stark Law and Anti-Kickback Rules Released
November 24, 2020 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On November 20, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) announced the issuance of long-awaited final rules to modernize the Stark Law and federal Anti-Kickback Statute (AKS). Proposed changes, intended to promote value-based arrangements for providers and coordinated care for patients, …
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OIG Issues Special Fraud Alert on Speaker Programs
November 20, 2020 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Fraud Alert on November 16, warning that speaker programs organized by pharmaceutical and medical device companies pose inherent fraud and abuse risks. OIG is “skeptical about the educational value of such programs” and cautioned that remuneration to referring practitioners …
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Medtronic Settles Kickback and Open Payments Violations for $9.2M
November 13, 2020 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on October 29 that Medtronic USA Inc. agreed to pay $8.1 million to settle allegations that it violated the False Claims Act (FCA) and federal Anti-Kickback Statute by paying kickbacks to a South Dakota neurosurgeon to use Medtronic’s medical devices. Medtronic will pay an additional $1.11 million for …
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Significant Changes to Simplify the OMIG Annual Compliance Certification Process
November 10, 2020 | Ashley (Osadon) Algazi | Legislation and Public Policy | Medicare and Medicaid
The New York State Office of the Medicaid Inspector General (OMIG) instituted changes to its annual compliance certification process, effective immediately. These changes apply to those Medicaid, Managed Medicaid, and Service Bureau providers subject to the mandatory compliance program requirements in Section 363-d of the New York State Social Services Law (SSL) and the Deficit …
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New Relief Funds; Eased Lending Terms for Accelerated Payments
October 30, 2020 | Rivkin Rounds Staff | Behavioral Health | COVID-19 | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes
An October 22 article in Part B News, “Welcome third round HHS relief funds, eased lending terms for accelerated payments,” discussed the Centers for Medicare & Medicaid Services’ Accelerated and Advance Payment Program (recently discussed here) and the Department of Health and Human Services’ CARES Act Provider Relief Program (recently discussed here). Rivkin Radler’s Eric …
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$50 Million Stark Settlement Shows Risk of Violation, Whistleblowers
October 21, 2020 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
An article in the November issue of Healthcare Risk Management, “$50 Million Stark Settlement Shows Risk of Violation, Whistleblowers,” discussed Wheeling Hospital’s $50 million settlement with the U.S. Department of Justice (DOJ) that resolved a whistleblower complaint filed in 2017 by a former executive of the hospital. Rivkin Radler’s Jeff Kaiser was quoted in the …
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Health Providers Get More Time to Repay Medicare Loans
October 15, 2020 | Rivkin Rounds Staff | COVID-19 | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes
On October 8, the Centers for Medicare & Medicaid Services (CMS) released new details on repayment terms for the Medicare Accelerated and Advance Payments Program, a loan program that sent aid to Medicare Part A providers and certain Part B suppliers to help the ease the financial burdens caused by the COVID-19 pandemic. CMS also …
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