News & Analysis as of

Medicare

CMS Publishes RADV Medical Reviewer Guidance

by Dentons on

In the Medicare Advantage (MA) context, "risk adjustment" is the process by which the Centers for Medicare & Medicaid Services (CMS) reimburses Medicare Advantage Organizations (MAOs) based on demographic factors and the...more

Early Victory: Judge Dismisses Qui Tam Suit Against UnitedHealthcare

by Arnall Golden Gregory LLP on

On October 5, 2017, in United States of America ex rel. Swoben v. Scan Health Plan, et al. (“Swoben”), Judge John F. Walter of the United States District Court for the Central District of California granted United Health...more

Corporate Actors Held Individually Accountable in Recent False Claims Act Settlement

The Department of Justice (“DOJ”) has sent a clear message that individuals cannot hide behind the corporate shield in its recent settlement with Med-Fast Pharmacy, Inc. and the charges brought against its associated...more

How to Reverse Medicare Surcharges When Your Income Changes

What happens if you are a high-income Medicare beneficiary who is paying a surcharge on your premiums and then your income changes? If your circumstances change, you can reverse those surcharges....more

Blog: OIG Releases October Work Plan Items; Includes Opioid REMS and Specialty Drug Coverage and Medicare Reimbursement

by Cooley LLP on

As we recently announced, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The October updates include 5 new Work Plan items...more

U.S. watchdogs tally $1.5 billion cost for one type of defective medical device

Big medical device makers, like Big Pharma, have complained Big medical device makers, like Big Pharma, have complained relentlessly that Uncle Sam hamstrings them with red tape and bureaucracy that slows or prevents...more

Disproportionate Share Hospital Payments: A Minibus Rider

As a part of our ongoing blog series we have provided details on the structure, funding, and outlook of several expiring health care provisions, that we’ve referred to as the health care minibus. The minibus includes all of...more

Federal Court Strikes DOJ's Risk Adjustment False Claims Act Case - For Now

by Pepper Hamilton LLP on

On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more

Now Is the Time to Review Your Medicare Options

Are you happy with your current Medicare plan or plans? Now is the time to think about whether you are in the right plan or whether a new plan could save you money. Medicare's Open Enrollment Period, in which you can enroll...more

OIG Finds Continued Procedural Errors in Hospital Outlier Payment Reconciliations

by Baker Ober Health Law on

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently released a report concluding that there are vulnerabilities in the process of reconciling Medicare hospital outlier payments....more

Will CMS Consider Your Institution to Be a Hospital? Guidance on the "Primarily Engaged In" Standard

by Baker Ober Health Law on

Recent guidance from CMS suggests that some hospitals, and particularly specialty hospitals that provide mostly outpatient care, may soon find themselves the focus of surveyors' scrutiny. In early September, CMS issued...more

OIG Finds Acute Care Hospitals Improperly Billed for Outpatient Services Provided to Inpatients of Other Hospitals

by Baker Ober Health Law on

Acute care hospitals that provide Medicare outpatient services to inpatients of other hospitals should be billing and collecting payment from the other inpatient hospitals and not from Medicare....more

CMS Memorandum Requires Legionella Risk Reduction in Healthcare Facilities

by Holland & Knight LLP on

According to a recent review of Legionnaires' disease outbreaks, 34 percent were associated with long-term care facilities and hospitals. Patients at risk of contracting Legionnaires' disease include smokers, those with...more

CHIP Reauthorization Legislation and Medicare-Medicaid Extender Provisions

by Holland & Knight LLP on

In this memorandum, Holland & Knight's Healthcare & Life Sciences Team summarizes recent legislative action on funding for the Children's Health Insurance Program (CHIP). The Senate Finance Committee and the House Energy...more

False Claims Act Watch: California Federal Judge Dismisses DOJ Complaint Alleging Medicare Advantage Fraud

by Kelley Drye & Warren LLP on

On October 5, the U.S. Department of Justice suffered a setback when a California federal judge dismissed its complaint under the civil False Claims Act (“FCA”). Billed as a test case for the Government, it marked the first...more

Trump Administration Shelves Additional Obama Medicare/Health Plan Proposals

by Reed Smith on

The Trump Administration has formally withdrawn a number of pending Department of Health and Human Services (HHS) proposals that never reached the final rule stage. This includes: a controversial Part Medicare B drug payment...more

CMS Announces CY 2018 Amount in Controversy Thresholds for Medicare Appeals

by Reed Smith on

CMS has released the calendar year (CY) 2018 amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The CY 2018 AIC threshold amounts...more

Chronic Care Legislation Approved by Senate

by Reed Smith on

The U.S. Senate has unanimously approved S. 870, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (as amended). The bill is intended to improve care for the chronically...more

CMS Corrects Final FY 2018 IPPS, LTCH, and SNF Payment Rules

by Reed Smith on

CMS has released corrections to two major fiscal year (FY) 2018 Medicare payment rules. First, CMS has made numerous technical corrections to the FY 2018 inpatient prospective payment systems (IPPS) and long term care...more

Capitol Hill Healthcare Update

by BakerHostetler on

Although the Children’s Health Insurance Program (CHIP) enjoys broad bipartisan support on Capitol Hill, lawmakers last week sharply disagreed over how to pay for its renewal – signaling that a final vote could be delayed for...more

Alert: In a Surprise Decision Issued on October 5, 2017, Honorable John Walter, United States District Judge, Dismissed a Medicare...

On October 5, 2017, the Honorable Judge John Walter of the United States District Court, Central District of California, granted the Defendants’ Motion to Dismiss the Medicare Advantage (“MA”) Federal False Claims Act (“FCA”)...more

CMMI Requests Ideas to Spur Innovation and Reduce Burden

by Polsinelli on

The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more

Senate Passes CHRONIC Care Act of 2017

by King & Spalding on

On September 26, 2017, the Senate passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The CHRONIC Care Act amends Title XVIII (Medicare) of the Social Security Act...more

CMS issues new guidance on interim rates for new teaching hospitals

by Dentons on

Prompted by confusion among Medicare Administrative Contractors (MACs) regarding how to initiate payments to new teaching hospitals, CMS issued on September 22, 2017, a One-Time Notification, Transmittal 1923, "Calculating...more

CMS Unexpectedly Withdraws Three Proposed Rules

The Centers for Medicare and Medicaid Services (CMS) recently announced the withdrawal of three proposed rules that, in one case, had been pending since 2014. The first proposed rule that CMS decided to scrap was proposed in...more

3,041 Results
|
View per page
Page: of 122
Cybersecurity

"My best business intelligence,
in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.