Medicare and Medicaid
March 11, 2020 | Eric D. Fader | COVID-19 | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes | Private Insurers | Telehealth
Over the past week, the Centers for Medicare & Medicaid Services (CMS) has issued a flurry of guidance documents and FAQs regarding COVID-19 for healthcare providers in private practice, hospitals, nursing homes, hospices and dialysis facilities, and for Medicare Advantage and Part D insurance plans. The guidance includes how to bill and collect for coronavirus
Read MoreMarch 6, 2020 | Eric D. Fader | COVID-19 | Legislation and Public Policy | Medicare and Medicaid | Telehealth
The “Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020,” signed into law by the President on March 6, includes provisions waiving Medicare’s geographic restrictions on telehealth during a public health emergency. This will enable healthcare providers to provide care via telehealth in urban and rural areas as well as in patients’ homes within the “emergency
Read MoreMarch 5, 2020 | Eric D. Fader | COVID-19 | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals | Private Insurers | Telehealth
On March 2, New York Gov. Andrew Cuomo announced new regulations on New York health insurers regarding coverage for coronavirus testing and related matters. The State Department of Financial Services (DFS) directive requires insurers to waive cost sharing for COVID-19 testing at emergency room, urgent care and office visits. In addition, Medicaid patients will not
Read MoreJanuary 21, 2020 | Ada Janocinska | Fraud and Abuse | Hospitals | Legislation and Public Policy | Medicare and Medicaid
In a recent Advisory Opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) approved a proposed arrangement whereby a hospital would offer discounted training to employees of one of the hospital’s referral sources, a local fire department.
The hospital is part of a non-profit health system that offers clinical training
Read MoreJanuary 17, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U. S. Department of Justice (DOJ) announced on January 15 that ResMed Corp., a San Diego-based manufacturer of durable medical equipment, will pay $37.5 million to the federal government to settle five qui tam (whistleblower) cases under the False Claims Act (FCA) alleging that ResMed paid kickbacks to DME suppliers, sleep labs and other
Read MoreJanuary 14, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
The U.S. Department of Justice (DOJ) announced last week that in the fiscal year ended September 30, 2019, it obtained more than $3 billion in total recoveries from civil cases brought under the False Claims Act (FCA). The total, a slight increase from the $2.9 billion recovered in the prior fiscal year, included both settlements
Read MoreJanuary 3, 2020 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth
Rivkin Radler’s Evan Krinick authored an article for the New York Law Journal, “The Broad Reach of the Medicare Fraud Strike Forces.” The article discusses recent strike force actions in New York and New Jersey that targeted a variety of healthcare fraud schemes.
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December 26, 2019 | Eric D. Fader | Hospitals | Medicare and Medicaid
A December 16 report by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) estimated that the Centers for Medicare & Medicaid Services (CMS) made tens of millions of dollars of inflated Medicare electronic health record (EHR) incentive payments over a four-year period. OIG examined a sample of 99 payments made
Read MoreDecember 11, 2019 | Eric D. Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Telehealth
The U.S. Department of Justice’s campaign against genetic testing scams continues and the latest accused lab owner is set to plead guilty. Ravitej Reddy, the owner of Personalized Genetics in Pittsburgh and Med Health Services Management in nearby Monroeville, was charged in November with paying kickbacks in a conspiracy to induce referrals for $127 million
Read MoreDecember 9, 2019 | Rivkin Rounds Staff | Fraud and Abuse | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid
The annual December 31st deadline for certain Medicaid providers and third-party billers to certify as to the effectiveness of their compliance program is fast approaching.
New York State Medicaid providers and third-party billing companies who claim, bill, order or receive at least $500,000 in any consecutive 12-month period from the Medicaid Program or Managed Medicaid
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