Medicaid

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
News & Analysis as of

North Carolina’s Medicaid RAC Program - Don't Let Your Guard Down

With Section 6411(a) of the Patient Protection and Affordable Care Act (ACA) and the Final Rules found at 42 CFR Part 455, the Recovery Audit Contractor (RAC) program has been expanded to the North Carolina Medicaid program,...more

Corridors Fall 2014 - Medicaid Reform – House Bill 1181, the Medicaid Modernization Act

With about 2.3 million North Carolina residents receiving Medicaid services for at least part of 2013, Medicaid reform is a top priority for the General Assembly. The significant funding allocations required to supplement the...more

Corridors Fall 2014 - News for NC Hospitals

In this issue: - North Carolina’s Medicaid RAC Program – Don’t Let Your Guard Down - A Primer on Medicare Requirements for Physician Supervision of “Incident to” Services - Hospital Options for Unused...more

Manatt on Medicaid: Arkansas—A Leading Laboratory for Healthcare Payment and Delivery Reform

Increasingly, states are moving beyond their traditional Medicaid programs to embrace new roles as leaders of statewide payment and delivery system transformation. The search for statewide solutions is fueled by cost...more

Eighth Circuit Rules Certain FCA Whistleblowers Are Not Required To Identify Specific Examples of Fraud Under Rule 9(b)

On August 29, 2014, the Eighth Circuit ruled that False Claims Act (FCA) whistleblowers with knowledge of employer billing practices are not necessarily required to identify specific examples of fraud to survive a Rule 9(b)...more

CMS Approves Pennsylvania’s Medical Assistance (Medicaid) Waiver

CMS approved Pennsylvania’s Medical Assistance (“Medicaid”) waiver request entitled Healthy Pennsylvania (“Waiver” or “Healthy Pennsylvania”) by letter dated August 28, 2014. Governor Tom Corbett and the Pennsylvania...more

7th Circuit Defines "Worthless Services" Under the False Claims Act

That’s the upshot from U.S. ex rel. Absher v. Momence Meadows Nursing Center, Nos. 13-1886 & 13-1936 (Aug. 20, 2014), a recent decision from the Seventh Circuit (authored by Judge Manion) that addressed the worthless-services...more

Health Care: Tackling DSRIP - Legal, Financial, and Clinical Issues for Non-Lead Providers (9/14)

Designed by New York State to seek a federal waiver for the expenditure of Medicaid funds, the Delivery System Reform Incentive Program (DSRIP) will allocate 6.42 billion dollars to health care providers in New York State to...more

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

What's the Difference Between Medicare and Medicaid in the Context of Long-Term Care?

Although their names are confusingly alike, Medicaid and Medicare are quite different programs. Both programs provide health coverage, but Medicare is an “entitlement” program, meaning that everyone who reaches age 65 and is...more

Telehealth and Health IT Policy: Considerations for Stakeholders

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

State Law Can Override Control Test for Employment

Past articles in this blog have discussed the control test for establishing an employment relationship as opposed to independent contractor status. Although government agencies such as the Department of Labor or IRS describe...more

CMS Says: Let's Make a Deal

In the hours before everyone began enjoying Labor Day Weekend, the Centers for Medicare & Medicaid Services (CMS) issued an important inpatient hospital review update....more

CMS Issues Final Rule for Inpatient Stays in Acute Care and Long Term Care Hospitals

On August 1, 2014, the Centers for Medicare and Medicaid Services (CMS) issued its annual final rule for policy and payment changes applicable to inpatient stays in acute care and long term care hospitals (Final Rule). This...more

Manatt on Medicaid: Pennsylvania Receives Federal Approval to Implement Medicaid Expansion

On August 28, 2014, the Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s application under Section 1115 of the Social Security Act to implement a Medicaid expansion effective January 1, 2015, through a...more

The Seventh Circuit Significantly Heightens the Bar for Proof in False Claims Act "Worthless Services" Cases

The United States Court of Appeals for the Seventh Circuit recently dealt a stinging blow to the False Claims Act (FCA) plaintiff's bar in United States ex. rel. Absher v. Momence Meadows Nursing Center, Inc. et al., Case...more

HHS OIG Issues Report on Questionable Billing for Medicaid Pediatric Dental Services

What you need to know: The Office of Inspector General for the US Department of Health & Human Services recently published the results of its study on Louisiana dentists who may be providing unnecessary dental...more

Seventh Circuit Limits “Worthless Services” Theory under False Claims Act

On August 20, 2014, the Seventh Circuit struck another blow against relators’ and the federal government’s increasingly aggressive False Claims Act theories of liability. Rejecting the relators’ use of the “worthless...more

AHRQ Releases Guidance for Reductions in Medicaid Hospital Readmissions

The Agency for Healthcare Research and Quality (AHRQ) has issued a comprehensive guide with an interactive toolkit for providers to target reductions in Medicaid hospital readmissions. While numerous CMS initiatives have...more

Health Care: Charting the Path Forward to DSRIP for Long-Term Care Providers (8/14)

Designed by New York State to seek a federal waiver for the expenditure of Medicaid funds, the Delivery System Reform Incentive Program (DSRIP) will allocate 6.42 billion dollars to health care providers in New York State to...more

New Federal Guidance on Reducing Medicaid Hospital Readmissions

The Agency for Healthcare Research and Quality (AHRQ) recently issued a guide to assist hospitals in reducing Medicaid patient readmissions. The AHRQ Hospital Guide to Reducing Medicaid Readmissions is the product of a...more

Prescription Drugs: Refocusing the False Claims Act Microscope on the Rest of the Transaction

Over the last decade, it has often felt as though the pharmaceutical industry has been the government’s and whistleblowers’ main, and at times only, target for False Claims Act (“FCA”) investigations. While manufacturers are...more

Efforts to Stop Health Insurance Fraud Through Use of Contractors Under Fire

In recent reports, from June 25, 2014 and August 13, 2014, the Government Accountability Office (GAO) highlights the mixed results achieved by the federal government's increased efforts to crack down on health insurance fraud...more

Seventh Circuit Finds Worthless Services Case Worthless

Two nurses filed a whistleblower suit against the Illinois nursing home where they worked. Their theory was that the care provided at the home was so poor that it was worthless. So any bills to Medicare and Medicaid were...more

Whistleblower Receives More Than $17 Million in Omnicare Case

A decision has been made in the case against Omnicare, Inc. that will net a former Omnicare pharmacist more than $17.2 million in the ensuing settlement. The settlement with the Department of Justice orders Omnicare,...more

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