News & Analysis as of

Medicare Part C Update: Co-Insurance Payments

Prior to the implementation of NC Tracks, the North Carolina Medicaid program would pay co-insurance for correctly filed claims for dual eligible residents (Medicare and Medicaid) who were covered primarily by Medicare Part C...more

Nursing Facility Survey Trends - Directed Plans of Correction, Privacy Violations and FTag 520 Quality Assurance Committee...

Directed Plans of Correction, or DPOCs, have long been part of the arsenal of enforcement sanctions available to the Centers for Medicare & Medicaid Services for survey deficiencies, just like civil money penalties (CMPs);...more

ACOs And Pay for Value … About the Data

It has been over three years since the Centers for Medicare and Medicaid Services (CMS) announced its proposed rule and guidance on the development and implementation of Accountable Care Organizations. About four million...more

Texas Medicaid Fraud Recovery Passes $400 Million Thanks to Whistleblowers

Operated jointly by federal and state agencies, Medicaid is one of the largest and most complex governmental undertakings in the United States. Not surprisingly, it also provides a breeding ground for fraud, primarily from...more

Software Glitch Sparks FCA Suit Against Hospitals for Late Repayment of Medicaid Reimbursements

On June 27, the New York Attorney General’s Office and the U. S. Attorney’s Office for the Southern District of New York intervened in a qui tam suit against Continuum Health Partners, Inc., Beth Israel Medical Center and St....more

Medicaid Claims And Health Care Fraud: As The Data Flows, New Cracks Emerge

As we noted in two of our prior posts in the Insider blog, the government has long touted its ability to rely upon data mining as a means of detecting fraud in the federal health care system, and has initiated a host of...more

The Senate Makes An Offer

House and Senate budget negotiators have been talking past one another for weeks now but today we have hope....more

Health Care Update - July 2014 #2

In This Issue: - Obama Administration Ramps up Efforts to Reduce Medicaid Spending - Senators Press Gilead on Sovaldi - Implementation of the Affordable Care Act - Other Federal Regulatory...more

Lots of Legislative Theater; No White Smoke

Lots of theater; no white smoke. - We are nearly two weeks into the new fiscal year with no budget agreement and no go-home date circled on the legislative calendar. Senator Apodaca promises his Senate Rules Committee...more

CMS Announces Dates for Sunshine Payment Review, Dispute & Correction Process

The Centers for Medicare & Medicaid Services (CMS) announced today that the Open Payments review, dispute and correction process will begin on Monday, July 14, 2014 and continue through September 11, 2014. ...more

Alabama Medicaid: Changes to the Regional Care Organization Statute

On May 17, 2013, Governor Bentley signed into law Act 2013-261, Ala. Code § 22-6-150 et. seq. As you may recall, the new law changed the Alabama Medicaid program from a fee-for-service program to a managed care program and...more

CMS Proposes Elimination of CME Exception to Sunshine Act Reporting

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule that includes a plan to eliminate the continuing medical education (“CME”) exclusion to the reporting requirements under the federal Physician...more

Medicare Fee Schedule and Florida PIP Coverage

In the state of Florida and other states that use no-fault auto insurance systems, specific issues involving insurance payouts are often part of traffic accident personal injury claims. Florida personal injury lawyers need to...more

The Government Intervenes In False Claims Act Case Alleging Failure To Return Overpayments Within 60 Days

On June 27, 2014, the United States intervened in a qui tam action under the False Claims Act alleging that certain New York hospitals failed to refund Medicaid overpayments within 60 days of identifying them, as required by...more

Healthcare Legal News - July 2014 • Volume 4, Number 2

In This Issue: - DO SUBSIDIZED HEALTH CARE PLANS PURCHASED UNDER THE AFFORDABLE CARE ACT TRIGGER THE ANTI-KICKBACK STATUTE? The advent of federally subsidized private pay health insurance under the Affordable...more

Harris v. Quinn Decision May Set Stage for Further Rulings Limiting Public Unions

On Monday, the U.S. Supreme Court decided Harris v. Quinn. As readers of my June 10 posting will recall, the plaintiffs in that case objected on First Amendment grounds to being required to contribute public union dues as a...more

Manatt on Medicaid: The Emerging Conversation About the Future of CHIP

During passage of the Affordable Care Act (ACA), a debate erupted over the future of the Children’s Health Insurance Program (CHIP), a well-established program that now offers coverage to 8 million children in low- and...more

Agency Fees Can’t Be Required for Illinois Rehab Personal Assistants, SCOTUS Rules

The State of Illinois cannot require Rehabilitation Program “personal assistants” (PAs) who decide not to join a union, to pay compulsory union dues, commonly known as “agency fees,” the U.S. Supreme Court ruled in Harris v....more

Radical Shift Coming In Public Sector Agency Fees

On Monday, the Supreme Court took a swipe at public sector compulsory unionism. In doing so, the Court took a slice out of decades of Supreme Court jurisprudence and suggested a future re-thinking of agency fees in the public...more

Commission-Based Sales Agreements for Medical Supplies and Equipment: More Whistleblower Activity on the Horizon? - A Wide Range...

The common industry practice of compensating independent contractor sales representatives on a "percentage of sales" commission basis may be creating an enhanced risk of False Claims Act liability for illegal kickbacks in...more

Supreme Court Rejects Labor’s Mandatory Dues Collection Initiative in Favor of Workers’ First Amendment Rights

Yesterday, the Supreme Court of the United States held that the First Amendment of the U.S. Constitution prohibits a public-employee union from collecting an agency fee from home-care workers who do not want to join or...more

Supreme Court Decides Harris v. Quinn

On June 30, 2014, the U.S. Supreme Court decided Harris v. Quinn, No. 11-681, holding that the First Amendment does not permit a state to compel public employees to subsidize speech on matters of public concern by a union...more

Two Significant Decisions Affecting Employers Issued the Final Day of the U.S. Supreme Court Session

On the last day of its 2013-2014 session, the U.S. Supreme Court held today that (1) for-profit companies are protected as "persons" under the federal Religious Freedom Restoration Act of 1993 (RFRA) and (2) that the...more

Supreme Court Strikes Down Mandatory Union "Fair Share" Deductions For Public Sector Employees

Today, in a 5 to 4 decision, the U.S. Supreme Court declined to extend its previous holdings regarding “fair-share” fees (fees that an employee who refuses to join a union is required to pay in lieu of union dues) to...more

United States Supreme Court Strikes Down Illinois Regulatory Framework Requiring Personal Assistants for Medicaid Recipients to...

In its much anticipated decision in Harris v. Quinn, 573 U.S. __ (2014), the Supreme Court of the United States in a five to four ruling struck down an Illinois regulatory framework that required personal assistants (PAs) for...more

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