Does violating requirements amount to fraud under the False Claims Act (FCA) when the requirements allegedly violated are unclear? There is currently a circuit split and petitions for review pending to the Supreme Court as to...more
On November 14, Judge Edward Chen in the Northern District of California issued rulings on the pending motions to dismiss in U.S. ex rel. Osinek v. Kaiser Permanente, granting in part and denying in part Kaiser’s motion to...more
Starting Oct. 1, per diem payments to skilled nursing facilities (SNFs) will be more generous on the first few days of a Medicare beneficiary’s stay, and then drop as the stay continues. That’s one of the changes under the...more
If you think you’re waiting even longer at your doctor’s office these days, you might be right. And it might be due to the overhaul of the medical billing code system that requires providers to enter an alphanumeric...more
As lawyers regularly representing community banks, we are frequently reminded of the level of regulatory scrutiny and intrusion experienced by the industry, and at times the almost laughable results of strained regulatory...more
CMS recently reminded providers that Medicare claims with a date of service on or after October 1, 2015, “will be rejected if they do not contain a valid ICD-10 code.” As CMS explained, “[t]he Medicare claims processing...more
Providers of behavioral health services should be aware that the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), released in May 2013 after more than ten years in...more
In recent months, as the conversation about reforming the health care system has shifted to achieving greater delivery system efficiencies, cost containment, and patient satisfaction, the role of health care...more