Medicare

News & Analysis as of

Florida's SIU Tool Belt Is a Bit Lighter Today

Florida has been plagued with insurance fraud for decades.  All insurance coverages are susceptible to fraud, but scams are especially prevalent in the context of automobile accidents.  Staged crashes, patient brokering,...more

District Court Allows Medicare Beneficiary Class Action to Proceed

On February 8, 2017, the United States District Court for the District of Connecticut declined to fully dismiss allegations filed by a class of Medicare patients against HHS in Alexander et al. v. Cochran (formerly Bagnall et...more

Medicare & Medicaid Remain Vulnerable to Fraud and Abuse, GAO Warns

The Government Accountability Office (GAO) is out with the latest installment of its “High-Risk Series,” which identifies federal programs “that are especially vulnerable to waste, fraud, abuse, and mismanagement, or that...more

Obamacare Reform Watch: Reimbursement Strategies in an Environment of Growing Out-of-Pocket Costs and an Expanding Self-Pay...

The increase in patient financial responsibility for health care costs in the past ten years has outpaced consumer growth in wages. This escalation of out-of-pocket costs represents a major revenue cycle challenge for health...more

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against...more

Change on the Horizon for Decades-Old Home Health Agency Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) has issued final regulations (CMS-3819-F) that will make substantial changes to the Medicare home health agency Conditions of Participation (CoPs). These sweeping changes...more

Health Care Fraud and Abuse in the Middle District of Florida in 2016 - a Year in Review

The United States Attorney’s Office (USAO) for the Middle District of Florida (USAO-MDFL) prosecuted several civil health care fraud matters in 2016 and issued related press releases. A review of the USAO-MDFL’s criminal and...more

OIG Publishes Online Portfolio Highlighting its Body of Work on Drug Pricing and Reimbursement

For several years now, the public outcry over the issue of drug pricing and reimbursement has increased in frequency and fervor. At least one government agency wants you to know that it has been listening and wants to help...more

What's "Hidden" in the 21st Century Cures Act for Health Care Entities

The 21st Century Cures Act (Cures) was signed into law December 13, 2016. While the primary focus of the 996-page Act centered on biomedical innovation, several components of Cures have significant implications for health...more

CMS Updates Manual Guidance to Include References to the Two Midnight Rule

Although the Two Midnight Rule was effective October 1, 2013, until recently, CMS had not updated the Medicare Benefit Policy Manual (MBPM) to incorporate the Two Midnight Rule and its revisions to prior admission...more

Health Care E-Note - Februaury 2017

Ransomware: A Reportable Breach? In the past several years, a huge increase has occurred in the number of electronic attacks in the United States using ransomware, a form of malware that targets and encrypts critical...more

HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

The U.S. Department of Health and Human Services (HHS) released a Final Rule aimed at reducing and eventually eliminating the backlog of more than 650,000 claims currently awaiting adjudication by an administrative law judge...more

Manatt on Health Reform: Weekly Highlights - February 2017 #2

Tom Price is confirmed as the new head of Health and Human Services; Georgia and Missouri legislatures call for new Medicaid waivers to implement capped funding; and the uninsurance rate hits a new low in 2016....more

Trump Administration Issues Proposed Health Insurance Market Stabilization Rule: Will It Be Enough to Stabilize Exchange...

On 15 February 2017, the Centers for Medicare & Medicaid Services (CMS) took a step toward addressing concerns about the stability of the individual and small group health insurance markets by proposing a modicum of...more

False Claims Act Alert: Fourth Circuit Punts on Sampling and Extrapolation

Tuesday, the Fourth Circuit Court of Appeals ruled in the interlocutory appeal in United States ex rel. Michaels v. Agape Senior Community, Inc.. In an opinion considering two significant questions arising under the qui tam...more

Home Health Agency Final Conditions of Participation Revisions Released by CMS

The Center for Medicare and Medicaid Services has issued a final rule that revises and modernizes the Conditions of Participation (COP) for Home Health Agencies. The Final Rule can be found in its entirety at: Final Home...more

Fraud and Abuse Investigations Should be Taken Very Seriously

According to the United States Government, fraud and abuse recovery has an excellent return for each investment dollar spent. According to the Health Care Fraud and Abuse Control (HCFAC) Program Report,released by the...more

Another Court Agrees That A Difference Of Opinion On Medical Necessity Is Insufficient to Show Falsity Under the False Claims Act

Last month, the U.S. District Court for the District of Utah joined the AseraCare court and others in finding that a relator cannot successfully allege violations of the False Claims Act (“FCA”) based on a purported lack of...more

Employees, Political Advocacy and the NLRB – What Can an Employer Do?

In the first few weeks of the Trump Presidency, there have been numerous marches, protests and other forms of political advocacy expressing views both in support of and in opposition to the President’s various appointments,...more

CMS Grants Eleventh Hour Extension for Attesting to Meaningful Use

Providers participating in the Medicare Electronic Health Record (EHR) Incentive Program now have an additional thirteen days to register and attest to meeting the meaningful use requirements for 2016. The Centers for...more

District Court Dismisses FCA Allegations Based Upon Difference of Medical Opinion

This month, the United States District Court for the District of Utah dismissed a relator’s allegations that a cardiac surgeon and two hospitals based in Utah violated the federal False Claims Act (FCA) by billing Medicare...more

CMS Provides Sneak Preview of Future DMEPOS Competitive Bidding Plans Before Retracting Announcement

One week after unveiling the next round of Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding, the Centers for Medicare & Medicaid Services (CMS) has announced a “temporary...more

Filling the Gaps in Medicare Can Be Difficult for SSDI Recipients

After two years, Social Security Disability Insurance (SSDI) beneficiaries are eligible for Medicare, the health insurance program designed for people age 65 and older. Medicare covers 9.1 million people with disabilities who...more

The Patient Is Not Always Right: Discriminatory Staffing Requests Can Create Legal Exposure

Employer reports of bigoted or inappropriate comments made by customers to employees or other patrons have become increasingly common for employers in all industries. In the healthcare industry, this often takes the form of a...more

Federal Court Blocks Aetna, Humana Merger

On January 23, 2017, the United States District Court for the District of Columbia granted the Department of Justice, Antitrust Division’s (DOJ) request for an injunction to block Aetna Inc.’s (Aetna) proposed acquisition of...more

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