Knicole Emanuel

Knicole Emanuel

Williams Mullen

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OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are full of people suffering...more

12/15/2014 - Health Insurance Healthcare MCOs Medicaid OIG

Proposed Federal Legislation Will Provide Relief to Hospitals and Medicare Patients in Need of Post-Acute Care

The Center for Medicare and Medicaid (CMS) announced that the new RAC contracts in North Carolina should be ready by the end of the year. This means that, next year, RAC audits on hospitals and other providers will...more

11/26/2014 - CMS Healthcare Hospitals Medicare Proposed Legislation RAC Audits RACs SNF

Obama’s Executive Order, Its Impact on Health Care Costs, and the Constitutionality of Executive Orders

Pres. Barack Obama addressed the nation last night. He discussed his executive order that will delay deportations of up to 5 million migrants. What does an executive order on immigration have to do with Medicaid?...more

11/21/2014 - Affordable Care Act Barack Obama Deportation Executive Orders Health Insurance Immigration Reform Medicaid

Supreme Court Will Decide Whether Citizens in NC and 26 Other States Can Receive Tax Credits for Health Care Premiums!!

With a decision that, I can only imagine, ricocheted against the White House walls, the Supreme Court granted certiorari to hear King v. Burwell this past Friday, November 7, 2014, despite Obama’s administration’s request for...more

11/13/2014 - Affordable Care Act Certiorari Employer Mandates Halbig v Burwell Health Insurance Exchanges IRS King v Burwell SCOTUS Subsidies Tax Credits

New Mexico Senator Proposes Forefront State Legislation to Provide Due Process to Providers Accused of Fraud (Oh, And Here Are...

Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new legislation protecting providers when it comes to...more

11/7/2014 - Allegations Due Process Election Results Fraud Healthcare Fraud Healthcare Providers Legislative Agendas

Source: [New Mexico] Human Services Secretary Squier Resigns!

“Gov. Susana Martinez’s controversial Human Services Department Secretary Sidonie Squier resigned on Thursday, sources inside the department confirmed,” according to the Santa Fe New Mexican....more

11/7/2014 - HHS Secretary of HHS

Black and Blue Medicaid Budgets, the ACA, and the Fear of the Unknown…

The unknown is what creates fear, right? For example, my husband is scared of heights. It is not the “heights” per se that scare him. He says that when he is high up, he gets an abnormal and understandably disturbing sense...more

2/4/2014 - Affordable Care Act CMS Healthcare Healthcare Reform Medicaid

Medicaid Card Warning: This Card Could Cause the State to Recoup From Your Estate!

Have you ever wondered about warning labels? I mean, some of them are so ridiculous that you have to wonder who the person was that created the need for such a ridiculous warning label. For example, the warning label...more

1/28/2014 - Estate Claims Medicaid

Possible Hospital RAC Audits in 2014: Pow! Right in the Kisser!

Whew…it’s a new year. While I thoroughly enjoyed 2013, I am excited and hopeful for 2014. Work is so busy that it seems like I’ve barely had time to breathe this January….that’s a good thing, right? Hey, anyone see me on...more

1/23/2014 - Audits Healthcare Hospitals Medicaid RACs

NCTracks Derailed: Class Action Lawsuit Filed!

My law partner Camden Webb and I filed a class action lawsuit today alleging on behalf of medical providers who accept Medicaid in North Carolina. ...more

1/16/2014 - Class Action Healthcare Medicaid

An Ominous Cloud Looms Over NC’s Mental Health System! And Radix Malorum Est Cupiditas!

Two phrases that can never be good when linked together: “an ominous cloud” and “mental health care system.” Upon reading “ominous cloud,” I get this dark (dare I say ominous?), dreary outlook on whatever the “ominous cloud”...more

1/15/2014 - Healthcare HHS Mental Health Parity Rule Mental Illness

NC Medicaid: With Diaz Gone, Who Will Provide the Cheery Soundbites About NC DHHS?

You know you know someone like this! No matter how horrible the circumstance, they just say positive things. You know, like a Disney character…oblvious to reality. Think about Snow White…her step-mother wants to kill her,...more

1/9/2014 - Medicaid

DHHS Blunder Could Cost Millions! “Oops I Did It Again!”

We can add one more “oops” to the Department of Health and Human Services (DHHS) repertoire of “oopses.” I am reminded of Captain Edward Smith when he banged the Titanic into an iceberg. Talk about an “oops” moment. Not to...more

1/8/2014 - Healthcare HHS HIPAA Medicaid Penalties

Hello, 2014! And Hello 3% Decrease in Medicaid Reimbursements (But Call the Decrease “Shared Savings”)

Tomorrow is the first Medicaid checkwrite for 2014. With the first Medicaid checkwrite tomorrow, due to Session Law 2013-360, many health care providers will receive 3% less in Medicaid reimbursements. You will receive a 3%...more

1/7/2014 - Healthcare Reform Medicaid Reimbursements

Medicaid Providers: Do Not Omit Information on Your Medicaid Application or NC Ct of Appeals Says, “You Can Lose Your Medicaid...

We’ve all told our share of little, white lies, right? “Yes, honey, you look fantastic in that dress!” Or… “I never think about my ex-boyfriend!” But omissions are also lies. People have told me in the past that omissions...more

1/3/2014 - Contract Formation Medicaid Omissions

CCME’s Prepayment Reviews Violate NCGS 108C-7!! Seriously!!

A few months ago I sent a public records request to the Division of Medical Assistance (DMA). I eventually received the information…today. I wanted to know how many providers had been put on prepayment review. ...more

12/27/2013 - Healthcare Professionals Medicaid Physician Medicare Reimbursements Physician Payments

CMS Declares the Payment Structure for the MCOs Violates A-87…”So What Happens Now?”

In North Carolina, we set up managed care organizations (MCOs) to manage behavioral health care for Medicaid. For the past year, I have been blogging that the MCOs’ payment arrangement with the Department of Health and Human...more

12/19/2013 - CMS Healthcare Healthcare Reform HHS Medicaid

If Men Are From Mars and Women Are From Venus, Then DHHS Is From Dune!

Without question, men and women see things differently. We process things differently. Which, of course, is why John Gray, Ph.D’s book “Men Are From Mars, Women Are From Venus” was such a huge success....more


The Assassination of Caesar, the Utter Ineptness of NCTracks, and Ignored Warnings

When Caesar was warned to “Beware the Ides of March,” Caesar would have known that the soothsayer was warning him about March 15th…a date certain. Similarly, the Department of Health and Human Services (DHHS) was...more

12/10/2013 - Affordable Care Act Healthcare HHS

Could NC Hospitals Be the Surprising and Much Needed Advocate for Mentally Ill Medicaid Recipients?

North Carolina has created the perfect storm when it comes to mentally ill…the perfect scenario for disaster. From 2001 to 2012, the total population of North Carolina increased from 8,203,734 people to 9,781,022. Over 1 and...more

12/10/2013 - Healthcare Hospitals Medicaid Mental Illness

Attention Medicaid Providers: Potential SPA Decreases PCS Rates By 60 Cents Per 15 Minutes

The North Carolina State Medicaid Plan (State Plan) is constantly revised. The result of its constant revisions make for an 1800+ page, jumbled mess of plans, rules, amendments, and effective dates that make the State Plan...more

12/5/2013 - Healthcare HHS Medicaid Personalized Medicine

Extrapolated Medicaid Audits Continue: Be Proactive! (Or Move to West Virginia)

Extrapolated audits are no fun, unless you work for a recovery audit contractor (RAC). You get a Tentative Notice of Overpayment (TNO) that says the auditor reviewed 100 dates of service (DOS), found an overpayment of...more

12/3/2013 - Audits Healthcare Medicaid Overpayment

MMIS and NCTracks: New is Not Always Better

New is not always better. In December 2008, the Department of Health and Human Services (DHHS) awarded a contract to Computer Sciences Corporation (CSC) to develop and implement a replacement billing system for Medicaid...more

11/27/2013 - Billing Contractors Medicaid

Lawmakers Demand Accountability as to NCTracks Debacle (Finally) and the Action of Nonaction

Yesterday (11/20/13), State Auditor Beth Wood appeared before the Joint Program Evaluation Oversight Committee meeting. Lawmakers and Wood criticized NCTracks, its rollout, and the lack of accountability on the part of the...more

11/22/2013 - Healthcare HHS

To Decrease Medicaid Spending (Without Decreasing Medicaid Recipients’ Services), Drastic Administrative Cuts Are Needed

It is indisputable that reigning in Medicaid costs is one of this administration’s top priorities. And, I agree, reigning in Medicaid costs should be a top priority. In fiscal year 2011, it is estimated that Medicaid...more

11/19/2013 - Healthcare HHS Medicaid

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