Howard Young on Medicare

CMS Proposes Additional Revisions to the 60-Day Rule

The Centers for Medicare & Medicaid Services has issued its Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule, scheduled for publication in the Federal Register on July 31, 2024. In response to industry...more

7/25/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Hospice Update: March Goes Out Like a Lion

The old adage—March comes in like a lion and goes out like a lamb—didn’t quite hold true for the hospice sector, which experienced a late-month flurry of activity. The government gave the hospice sector a lot to consider,...more

4/3/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Hospice , Medicare

Medicare’s New Dementia GUIDE Model: How Can Physicians, Hospices, and Home Health Agencies Participate?

If you have had a loved one suffer from dementia, you know the emotional, physical, and financial toll of this terrible disease. With advancements in dementia treatment, however, there is renewed hope on addressing this...more

3/4/2024 / Centers for Medicare & Medicaid Services (CMS) , Dementia , Health Care Providers , Home Health Care , Medicare

Florida Healthcare Director Charged in Fraud Case Against CMS

Continuing its recent slate of high-profile indictments, convictions, and plea agreements involving healthcare executives who have violated federal healthcare laws, the US Department of Justice (DOJ) recently announced...more

1/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , Health Care Providers , Healthcare Fraud , Medicare , Popular

CMS Increases Hospice Scrutiny through Provider Enrollment and Oversight Tools

The US Centers for Medicare & Medicaid Services (CMS) has implemented a final rule, effective November 13, 2023, designed to enhance the oversight of hospice providers throughout the United States and increase regulatory...more

11/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Physicians

Hospice in the Crosshairs: Medicare’s Enhanced Oversight and Newly Announced Audit Pilot

For over a year, the hospice industry, legislators, and state and federal regulators have expressed concerns about the fast growth and potentially unscrupulous activities of new hospices in several states in particular. Those...more

7/17/2023 / Audits , Centers for Medicare & Medicaid Services (CMS) , Hospice , Medicare , SMRC

Hospice General Inpatient Services (GIP): New OIG Audit Alert

The HHS Office of Inspector General (OIG) announced on June 15, 2023 that it plans to initiate a new audit of Medicare payments for hospice general inpatient (GIP) services, focused on hospice GIP services furnished to...more

6/21/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospice , Medicare , OIG , SMRC

How the End of the PHE Will Impact the Healthcare Industry

The Biden administration announced on January 30, 2023 that the COVID-19 Public Health Emergency (PHE) would officially end on May 11, 2023. The PHE declaration, which first was issued by the Secretary of the US Department of...more

5/11/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Emergency Use Authorization (EUA) , Food and Drug Administration (FDA) , Life Sciences , Medicare , OCR , Public Health Emergency , Telehealth

OIG Hospice Audits of Provider Relief Fund Use Have Arrived

The HHS Office of Inspector General (OIG) has, for the last several years, been actively auditing hospices regarding their Medicare regulatory and billing compliance, with a national hospice audit in the works. Recently, OIG...more

11/15/2022 / Audits , CARES Act , Compliance , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Hospice , Medicare , OIG

OIG Planning Nationwide Audit of Hospice Eligibility – What You Should Know

The HHS Office of Inspector General (OIG) recently announced its Office of Audit Services plans to conduct a nationwide review of hospice eligibility, focusing on those Medicare hospice beneficiaries who haven't had an...more

1/19/2022 / Audits , Certifications , Department of Health and Human Services (HHS) , Elder Care , Health Care Providers , Home Health Care , Hospice , Medicare , OIG

MA Audit: Hospices Unaware of Dual Eligibles Medicaid Filing Rule, Causing Potential Overpayments

The US Department of Health and Human Services, Office of Inspector General (OIG) recently transmitted a memorandum to the Center for Medicaid and CHIP Services detailing the findings of the Massachusetts state auditor's...more

11/3/2021 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Hospice , Medicaid , Medicare , OIG , Overpayment

CMS Relaunches Hospice TPE Audits with Long-Stay General Inpatient Reviews

The Centers for Medicare and Medicaid Services (CMS) announced that it had restarted the Targeted Probe and Educate (TPE) audit process, effective September 1, 2021. More recently, the Medicare Administrative Contractors for...more

10/20/2021 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Hospice , Medicare , OIG

Hospice: Consolidated Appropriations Act Revamps Medicare Survey and Certification Process

Modifications also include public disclosure of accreditation organization survey information and intermediate civil penalty remedies for noncompliance. The Consolidated Appropriations Act, 2021 (Pub. L. 116-260), signed into...more

1/13/2021 / Certification Requirements , Consolidated Appropriations Act (CAA) , Department of Health and Human Services (HHS) , Healthcare Reform , Hospice , Medicare , OIG , Regulatory Requirements , Surveys

Respite Care Flexibility During the COVID-19 Pandemic – A Pragmatic Legislative Fix

Imagine you are the primary caretaker for your 94-year-old terminally ill mother who lives in your home while under hospice care during the coronavirus (COVID-19) pandemic. ...more

8/7/2020 / Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Hospice , Legislative Agendas , Medicare , Nursing Homes , Relief Measures

CMS to Restart Medicare Audits Beginning August 3

The Centers for Medicare and Medicaid Services (CMS) recently announced that it intends to resume both prepayment and postpayment medical reviews conducted by the Medicare Administrative Contractors, Supplemental Medical...more

7/20/2020 / Audits , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Independent Medical Review , Medicare , Regulatory Requirements , Relief Measures

DC Circuit Court: CMS Rule on Drug Pricing Disclosure Exceeds Statutory Authority

In an informative decision for challenging rules that portend government overreach, the US Court of Appeals for the District of Columbia Circuit upholds the invalidation of the Centers for Medicare and Medicare Services’ drug...more

6/22/2020 / Centers for Medicare & Medicaid Services (CMS) , Disclosure Requirements , Drug Pricing , Medicare , Pharmaceutical Industry , Prescription Drugs , Transparency

CMS Expands Hospice Flexibilities to Fight COVID-19

CMS posted an expanded set, dated April 29, of Medicare regulatory flexibility measures for hospice organizations related to the coronavirus (COVID-19) pandemic, supplementing the previous COVID hospice flexibilities guidance...more

5/8/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Hospice , Medicare , Quality Assurance Programs , Relief Measures , Telehealth

CARES Act Relief Funds Offer Aid to Healthcare Providers, but Certifications and Overly Creative Use of Funds Are a Fraud Risk

Medicare (and in the future Medicaid) providers that receive grant money under the CARES Act Relief Fund must pay close attention to the terms and conditions of the assistance and rigorously document how the funds are used to...more

4/23/2020 / CARES Act , Coronavirus/COVID-19 , False Claims Act (FCA) , Federal Loans , Financial Stimulus , Health Care Providers , Medicaid , Medicare , Relief Measures

Mere Differences of Judicial Opinion Emerge to Muddle Healthcare Providers False Claims Act Exposure for Mere Differences of...

In the Care Alternatives False Claims Act (FCA) appeal, a panel of the US Court of Appeals for the Third Circuit on March 4 reversed the summary judgment granted to hospice provider Care Alternatives at the district court,...more

3/6/2020 / Appeals , Cooperative Compliance Regime , Department of Justice (DOJ) , Eligibility Determination , Enforcement Actions , False Claims Act (FCA) , Fraud and Abuse , Health Care Providers , Healthcare Facilities , Healthcare Fraud , Hospice , Medicare , Medicare Billing Privileges , Qui Tam , Reversal , Risk Management , Whistleblowers

$1 Million Settlement Reached in AseraCare FCA Case

In an action especially significant to hospice providers but also other healthcare providers regarding the determinations of medical necessity for Medicare billing purposes, the US Department of Justice (DOJ) and AseraCare...more

2/28/2020 / Department of Justice (DOJ) , Enforcement Actions , False Billing , False Claims Act (FCA) , Fraud and Abuse , Health Care Providers , Health Insurance , Healthcare Fraud , Medical Necessity , Medicare , Medicare Billing Privileges , Qui Tam , Settlement Agreements

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