Tag archive: medicaid

New Final Rule for National Emergency Preparedness for Medicare/Medicaid Providers & Suppliers

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…

CMS Issues Proposed Rule to Overhaul Part B Drug Payments

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%…

Beware of Low Hanging Fruit – OIG Targets for Fraud and Abuse

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…

New Risk for Hospitals – CMS Proposes Bundled Payments for Hip & Knee Replacement Surgeries

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…

Learning the Hard Way – Omnicare to Pay $124M False Claims Settlement

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it. The Department of…

Doctor Beware – Certification for Home Health Care is a Referral

On February 10, 2015, the Seventh Court of Appeals decided the matter of U.S. v. Kamal Patel, No. 14-2607, upholding the conviction of a physician for violating the anti-kickback statute.

HEAT Settlement Resolves Alleged Inducement of Medicare and Medicaid Business

Next time you wonder how seriously the Department of Justice (DOJ) and its Health Care Fraud Prevention and Enforcement Action Team (HEAT) takes fraud and abuse, be assured they are very serious. This recently announced settlement arose from allegations the DOJ received from a whistleblower that Rite Aid provided gift cards to Medicaid and/or Medicare…

Health Care Providers Beware – Overpayment Claim News

Two recently announced settlements with Washington State and the Federal government show two potential overpayment issues for providers. Molina Healthcare of Washington, Inc., announced in an SEC filing on September 5th, that it agreed in principle with the Washington Health Care Authority (HCA) to settle the two outstanding overpayment matters brought by HCA demanding recoupment…

Learning the Hard Way – Omnicare to Pay $124M False Claims Settlement

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it. The Department of…

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