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Category Archives: Medicare

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Corporate Actors Held Individually Accountable in Recent False Claims Act Settlement

Posted in False Claims Act, Fraud and Abuse, Medicare, Pennsylvania, Prescription Drugs and Medical Devices, Trends
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 individuals and entities (“Med-Fast”). Under the agreement, which includes a $2.66 million payout by Med-Fast, the DOJ dropped civil charges against the… Continue Reading

Anchors Away! Physical Therapists Rejoice (and Book a Tropical Getaway) as CMS Extends Locum Tenens Arrangements

Posted in Legislation, Medicare, News from the Health Law Gurus, Regulations, Trends
Even doctors get sick sometimes, or need to take a vacation, and when they do, patients are not seen and billing does not happen. Cue locum tenens – a system used by providers to ensure continuity of care and revenue when providers need to complete continuing medical education requirements or take time off for vacations… Continue Reading

Mental Health Reform Act of 2015 Proposes Overhaul to America’s Mental Health System

Posted in Guest Contributor, Legislation, Medicaid, Medicare
On Tuesday, August 4, Senators Chris Murphy (D-Conn) and Bill Cassidy (R-La) introduced The Mental Health Reform Act of 2015. The bill proposes reforms to Medicare and Medicaid, introduces new grant programs, and enhances the federal government’s commitments to integrating physical and mental health and improving mental health services. According to Murphy, the bill will… Continue Reading

CMS Issues Final Rule for Medicare Shared Savings Program

Posted in Accountable Care Organizations, Guest Contributor, Medicare
This month, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule (the “Final Rule”) regarding an update to the Medicare Shared Savings Program (the “Program”). The Final Rule will seek to enhance primary care services, reduce administrative burdens, and provide flexibility in the Program in order to maintain and enhance participation in… Continue Reading

Health Care Payment Learning and Action Network Is Open for Registration

Posted in Guest Contributor, Medicare
On March 25, 2015, the Centers of Medicare and Medicaid Services (“CMS”), launched the Health Care Payment Learning and Action Network (the “Network”), an ambitious  private-public partnership designed to further move the health care system away from quantity-based care and closer to value-based, quality-driven care. The Network is being established to “help the U.S. health… Continue Reading

One Step Forward, One Step Out the Door – Senate Action Needed for SGR Repeal

Posted in Legislation, Medicare
The House of Representative recently passed legislation, by a sweeping vote of 392-37, which aims to change the way physicians are paid. The legislation, called the Medicare Access and CHIP Reauthorization Act, repeals and replaces Medicare’s sustainable growth rate formula (“SGR”). Despite the broad bipartisan support the legislation received in the House, the Senate failed… Continue Reading

OIG Report Outlines Five Recommendations for Hospice Care Reform

Posted in Affordable Care Act (ACA), Medicare
The Patient Protection and Affordable Care Act requires the Centers for Medicare and Medicaid Services (“CMS”) to reform the hospice payment system, collect data relevant to revising hospice payments and develop quality measures for hospices. In a recently released report, the U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) made several… Continue Reading

News from the Health Law Gurus™: Week of August 24, 2014

Posted in Affordable Care Act (ACA), Anti-Kickback Statute, Medicare, News from the Health Law Gurus, OIG Advisory Opinion, Trends
News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every week for the latest health law news stories. CMS Bolsters Roster Before Next Health Insurance Marketplace Open Enrollment Period – The Department of Health and Human Services… Continue Reading

News from the Health Law Gurus™: Week of May 11th, 2014

Posted in Fraud and Abuse, Medicaid, Medicare, News from the Health Law Gurus
News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every Friday for the latest health law news stories. OIG to Expand Its Exclusion Authority under Proposed Rule—In a proposed rule published in the Federal Register last week,… Continue Reading

News from the Health Law Gurus™: Week of April 20th, 2014

Posted in Compliance Issues, FDA, HIPAA, Medicare, News from the Health Law Gurus, Privacy, Regulations
News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every Friday for the latest health law news stories. Passwords Affected from Heartbleed – HealthCare.gov, the website for the federally-facilitated health insurance exchanges under the Affordable Care Act,… Continue Reading

If It’s Broken, Fix It (At Least Temporarily): New “Doc Fix” Law Prevents Automatic Medicare Pay Cuts to Physicians

Posted in Legislation, Medicare
Were you worried that your physician pay rate would plummet come March 31 due to Medicare’s sustainable growth rate (“SGR”) formula? You can stop pulling out your hair, at least until next year. On April 1, 2014, President Obama signed into law a bill that stops automatic Medicare payment cuts due to SGR from taking… Continue Reading

I’ll Be Watching You: Medicare Billing Info on over 880,000 Providers Released by CMS to Improve Transparency

Posted in Compliance Issues, Fraud and Abuse, Medicare
Every payment you take, every claim you make, someone will be watching you. No, we don’t mean Sting. We mean all the consumers and businesses that will have greater access to physician billing information now because today the Centers for Medicare and Medicaid Services (“CMS”) released billing and payment information for over 880,000 practitioners. This… Continue Reading

Seeing Dollar Signs: U.S. Settles with Ophthalmologist for $1.4 Million to Resolve FCA Claims

Posted in False Claims Act, Fraud and Abuse, Medicaid, Medicare
Last week, the United States settled with a Baltimore ophthalmologist for alleged violations of the False Claims Act (“FCA”). Pursuant to the settlement, the ophthalmologist, Dr. John Arthur Kiely, agreed to pay $1.4 million to the government and to be excluded from participation in Medicare and Medicaid for 20 years. Generally, the FCA imposes civil… Continue Reading