"Nationwide Healthcare Lawyers"
(June 26, 2018): The coverage of personal care services by Medicare has been advocated by advocacy groups for many years. As we reported last April, the Centers for Medicare and Medicaid Services (CMS) announced in its Final Call Letter for bids from plans that participate in the Medicare Advantage program (MA) for 2019. In that […]
(Updated June 18, 2018): According to the Association of Certified Fraud Examiners, money lost due to fraud costs businesses and private parties over $3.5 trillion per year. This information, coupled with their assertion that instances of fraud have been dramatically increasing within the last few years, offers an eye-opening revelation not only for business, but
What is Civil Fraud? Read More »
(April 12, 2018): A big concern with the Medicare appeals process is the ghastly backlog at the Office of Medicare Hearings and Appeals (OMHA) for an Administrative Law Judge (ALJ) hearing coupled with the government’s authority to recoup alleged overpayments after the second level of appeal (reconsideration). There is renewed buzz regarding the backlog and
(April 10, 2018): On April 2, the Centers for Medicare and Medicaid Services (CMS) announced an expansion of the benefits that private health plans may offer Medicare beneficiaries under the Medicare Advantage (MA) program in 2019. In its Final Call Letter for bids from plans that participate in the MA program (“MA plans”) for 2019,
Medicare Advantage Plans May Soon Offer Personal Care Services Read More »
(January 26, 2018): From Churches to Congress, sexual harassment and assault charges have plagued many of the institutions that our society holds dear. As revelations of sexual misconduct continue to surface, we continue to learn of the many abuses of those in powerful positions; those whom we once revered. The rise of the #MeToo Movement
Sexual Harassment: Cases Against Texas Physicians in 2017 Read More »
(January 25, 2018): On January 23rd, the Veteran Administration (VA) and the Centers for Medicare and Medicaid Services (CMS) announced a “partnership to strengthen prevention of fraud, waste and abuse.” According to the press release, under this partnership: “VA plans to capitalize on the advancement in analytics CMS has made by concentrating on its use
Veterans Administration and CMS Announce Partnership to Address Fraud Prevention Read More »
(January 2, 2018): Congratulations to our very own Michael Cook who has been appointed to serve on the Virginia Medicaid Policy Council for Health and Human Resources. In this role, The Council’s role is to provide recommendations on policy issues involving the programs operated by the Department of Health and Human Resources as part of the transition.
Michael Cook appointed to serve on Virginia’s Medicaid Policy Council Read More »
Compliance Guidance (April 14, 2017) Recently, the Office of Inspector General of the United States Department of Health and Human Services (OIG) and the Criminal Division of the Fraud Section at the United States Department of Justice (DOJ) have issued guidance on measuring the effectiveness of corporate compliance programs. In February, DOJ placed on its
OIG And DOJ Issue Important New Compliance Guidance Read More »
(January 20, 2017): The Medicare appeals backlog has reached its all-time worst. If you’re a healthcare provider or supplier waiting for a hearing before an Administrative Law Judge (ALJ) at the Office of Medicare Hearings and Medicare Appeals (OMHA) – the third level of the Medicare appeals process – you’ve likely been waiting years to
HHS Issues Final Rule to Address Record High Medicare Appeals Backlog Read More »
(November 23, 2016): The Office of Audit Services, Office of Inspector General (OAS), is in the process of conducting audits of large home health agencies. These audits are being conducted, in part, because the Centers for Medicare and Medicaid Services (CMS) had determined through the Comprehensive Error Rate Testing Program (CERT) that for 2014, there
Responding to OIG Home Health Audits Read More »
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