Medicaid Compliance

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

OIG Proposes Updates to Exclusion and CMP Authority

The Department of Health and Human Services, Office of Inspector General (OIG) recently issued a pair of proposed regulations to update its exclusion and civil monetary penalty (CMP) authority. The proposed regulations...more

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

OIG's 2014 Work Plan: A Roadmap to Key OIG Fraud and Abuse Priorities

The Department of Health and Human Services, Office of the Inspector General (OIG) released its Fiscal Year (FY) 2014 Work Plan on January 31, 2014. While the OIG usually releases its work plan in October of each year, in...more

ADA Accessibility Attestation Forms for FIDA (Medicare-Medicaid Advantage Duals) Plans

The Financial Alignment Initiative of the Centers for Medicare & Medicaid Services ("CMS") is a test program designed to better coordinate care for dual Medicare-Medicaid enrollees by aligning the financing of Medicare and...more

Hospitals And Compliance

Hospitals are being squeezed on many fronts – government reimbursement for medical services are declining, government regulatory requirements are increasing, and the prospects for improvement are dwindling. Medicare and...more

Healthcare Regulation Update: CMS to Develop New Integrity Contractors Called “Unified Program Integrity Contractors”

The American Health Care Association (“AHCA”) has reported that the Centers for Medicare & Medicaid Services (“CMS”) will be making efforts to streamline its audit structure. Among the changes will be the development of a new...more

New Requirement for LTC Facilities That Arrange Hospice Services through a Medicare-Certified Hospice

Effective August 26, 2013, the Centers for Medicare & Medicaid Services require that a long-term care, or LTC, facility that chooses to arrange for the provision of hospice services through a Medicare-certified hospice must...more

CMS Rule Complicates Long-Term Care Facility and Hospice Relationships

Final rule aims to improve the quality and consistency of care between long-term care facilities and hospice providers but may increase conflict between facility and provider staff. ...more

2013 Healthcare Fraud and Abuse Bootcamp Webinar Series, Part V: Compliance

Bill Mathias of Ober|Kaler's Health Law Group presented on compliance as a part of the 2013 Healthcare Fraud and Abuse Bootcamp Webinar Series sponsored by the American Health Lawyers Association. This webinar...more

Final Regulations Governing Closure of Long Term Care Facilities

The federal Centers for Medicare and Medicaid Services (CMS) published a final regulation to further implement section 6113 of the federal health reform law, the Patient Protection and Affordable Care Act. The March 19, 2013,...more

CMS Publishes Final Sunshine Act Rule; Data Collection to Begin on August 1, 2013

The long-awaited final rule (the Final Rule) implementing the Physician Payments Sunshine Act (Sunshine Act) has arrived at the Federal Register. It amends key definitions and adds new terms; retains broad reporting...more

CMS Issues Final Physician Payment Sunshine Rule

In an action that will have broad implications for drug and device manufacturers, researchers, distributors, teaching hospitals and physicians, on February 1, the Centers for Medicare and Medicaid Services (CMS) publicly...more

Major New Jersey Health System Pays $12.6 Million To Settle False Claims Act Suit Alleging Physician Kickback Scheme

Federal prosecutors recently announced a $12.6 million False Claims Act (FCA) settlement with a major New Jersey health system to resolve allegations that the system paid outside physicians in order to increase referrals....more

Record Healthcare Fraud Recovery Calls for Compliance

To date in 2012, the Department of Justice secured a record $3.3 billion in settlements and judgments in civil cases alleging healthcare fraud against the government under the Federal False Claims Act (“FCA”). The figure,...more

Mandatory Compliance Programs for Healthcare Companies

The healthcare industry always has taken the lead in compliance issues, developing innovative compliance tools and programs. Anti-corruption compliance borrows heavily from many healthcare compliance ideas....more

Government Teams with Insurance Companies to Combat Healthcare Fraud

At Ashley D. Adams, PLC, we have a well-established track record of success in false claim cases that can make a difference. For both organization defending against false claims charges and individuals pursuing qui tam...more

The Healthcare Sector and the Future of ACA Implementation

Even with the lingering uncertainty over Medicaid program expansion, the High Court's decision brings some certainty and the need to focus on ramifications of ACA implementation. On June 28, the U.S. Supreme Court held...more

Q&A on the U.S. Supreme Court's Decision on Healthcare Reform

On June 28, 2012, the U.S. Supreme Court issued its long-awaited ruling on the constitutionality of President Obama's health care reform legislation. The decision resulted in numerous questions due to the complexity of the...more

UPDATE: Key Provisions of 2010 Healthcare Reform Legislation for Large (50+) Employers

Yesterday, June 28, 2012, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act, with the exception that the Federal government's power to terminate Medicaid funding is to be narrowly read. The main...more

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