Following recent natural disasters, such as Hurricane Sandy or episodes of serious flooding; the Centers for Medicare and Medicaid Services (CMS) published a Final Rule to help Medicaid & Medicare providers and suppliers plan for natural and man-made disasters. The new regulations provide consistent emergency preparedness requirements with a goal of enhancing patient safety during…
Discarded pharmaceuticals and the high cost of drugs continue to receive attention in the news, as well as from the Centers for Medicare and Medicaid Services (CMS). In response to these concerns, CMS recently issued a mandate updating the use by hospitals of the JW modifier to document discarded drugs or biologicals in patient’s medical…
The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule to reduce Medicare expenditures by changing the way it makes payments for Part B drugs. The proposal includes two phases. The first involves changing the percent of add-on to the Average Sales Price (ASP) of the drugs from 6% to 2.5%…
On February 9, 2016, CMS issued an update announcing changes related to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law on April 16, 2015. The changes extend the therapy cap exception process through December 31, 2017. MACRA also modifies the requirement for manual medical review for services over the $3,700…
Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures often due to osteoporosis. Since the filing of a qui tam action, more than 130 hospitals have entered settlements with the Department of Justice (DOJ) totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. On December 18, 2015,…
Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability. Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice…
Demonstrating the government’s commitment to combat health care fraud and keeping providers accountable, the U.S. Attorney’s office of Southern District announced that Regent Management Services L.P., a long term provider, agreed to pay approximately $3.199 Million to settle allegations that it received kickbacks from ambulance companies for referrals of Regent’s Medicare and Medicaid patients needing…
On June 18, 2015, the US Attorney announced two investigations resulting in a number of accusations of Medicare and Medicaid fraud and abuse. The “Home Alone IV” take-down and the largest national health care fraud take-down to date involving more than 200 subjects accused of defrauding Medicare and Medicaid of more than $700 Million in…
Building upon the bundled payment demonstration programs currently underway for Medicare, the Centers for Medicare and Medicaid Services (CMS) announced a proposal for a major shift in the way hospitals will be paid for hip and knee replacements. In an effort to incentivize hospitals to encourage quality and care improvements as patients transition from surgery…
Summer’s almost here and the weather is heating up for HEAT, the Department of Justice’s (DOJ) task force to combat healthcare fraud. This whistleblower initiated action was brought to the attention of the government by a former pharmacist employed by PharMerica. The settlement announced today relates to allegations of dispensing Schedule II controlled drugs without…