Medicare, Compliance | JD Supra Law News

Hospitals: Audits And Compliance

by Michael Volkov on 4/2/2013

Hospitals are under intense scrutiny. The federal government knows that one sure way to reduce healthcare costs is to get hospitals to lower their costs. Hospitals feel the pinch given the need to generate revenue but know...more

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

by Donna Senft | Ober|Kaler on 3/30/2013

In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

Final Regulations Governing Closure of Long Term Care Facilities

by Howard Sollins | Ober|Kaler on 3/29/2013

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

OIG Recommends Increased CMS Enforcement of SNF Standards

by Holly Barker, Kathleen McDermott | Morgan Lewis on 3/22/2013

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

Deferred Prosecution Agreements: How an Effective Compliance Program Can Help You Plan for the Unpredictable

by John S. Linehan, Gina L. Simms | Ober|Kaler on 2/27/2013

During the past several years, prosecutors have increasingly used Deferred Prosecution Agreements (DPAs) against corporations in enforcing white collar criminal statutes. DPAs have enabled companies to avoid the costs and...more

Health Care Enforcement in 2012: A Year in Review

by Hope Foster, Samantha Kingsbury, Tracy Miner, Jessica Sergi, Stephanie Willis | Mintz Levin - Health Law on 2/26/2013

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

CMS Announces Proposed Rule Implementing the ACA's MLR Requirements for MA and Prescription Drug Plans

by Darryl Landahl, Ishra Solieman | Brownstein Hyatt Farber Schreck on 2/22/2013

On February 15, the Centers for Medicare & Medicaid Services (CMS) released its Proposed Rule, effective calendar year (CY) 2014, implementing the Medical Loss Ratio (MLR) requirements for Medicare Advantage (MA)...more

CMS Issues Final Physician Payment Sunshine Rule

by Michael Werner | Holland & Knight LLP on 2/5/2013

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

by Henry E. Hockeimer, Jr., Evan Krick, Dee Spagnuolo | Ballard Spahr LLP on 1/31/2013

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

Audits, Audits And More Audits: Life In The Healthcare Industry

by Michael Volkov on 1/13/2013

Healthcare suppliers and service providers live in a regulated world. They are constantly under audit scrutiny. Sometimes federal agencies (i.e private contractors) conduct the audits; other times state agencies conduct the...more

Mandatory Compliance Programs for Healthcare Companies

by Michael Volkov on 9/28/2012

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

Payment Matters: Medicare's Three-Day Window is Fully in Effect: Are You in Compliance?

by Ober|Kaler on 8/23/2012

In Section 102 of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, Congress expanded Medicare's three-day payment window policy to apply to certain therapeutic services furnished...more

Government Teams with Insurance Companies to Combat Healthcare Fraud

by Ashley Adams on 8/10/2012

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

by Morgan Lewis on 7/17/2012

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

Healthcare Reform: What Connecticut Employers Need to Know After Supreme Court’s Health Law Ruling

by Pullman & Comley, LLC on 7/16/2012

On June 28, 2012, the Supreme court ruled that the Patient Protection and Affordable Care Act (the “Act”) is constitutional. What does the decision mean for employers? The Supreme Court’s decision rests on some...more

What Do Healthcare Reform and the "Fiscal Cliff" Have In Common? Tax Increases

by Venable LLP on 7/9/2012

On June 28th, the U.S. Supreme Court upheld the new healthcare reform law in part by ruling that the individual mandate is a tax and Congress has authority to impose the individual mandate under Congress’s taxing power. As a...more

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Medicare › Compliance