Two cases brought against an Alabama-based hospice company will result in an almost $6 million settlement payment. In two whistleblower complaints filed in 2013 by two former employees, one of which who worked as a clinical director in a Pennsylvania branch, SouthernCare Inc. is accused of wrongly billing Medicare for unnecessary hospice care. When the […]
The Eliminating Kickbacks in Recovery Act of 2018 (“EKRA”) became effective October 24, 2018. ERKA makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive any remuneration (i.e., anything of value), directly or indirectly, overtly or covertly, in cash or in kind, to induce a referral (or in exchange for a […]
The New York State Office of the Medicaid Inspector General (OMIG) maintains a Certification Program to ensure Medicaid providers are continuing proper compliance. This program works to eliminate any environment in a Medicaid provider’s system that may encourage fraud, waste, or abuse, as well as ensuring errors have the potential for self-correction if mistakes are […]
The practice of diagnosis and treatment of patients remotely by way of a telecommunications technology, also known as telemedicine, has gained popularity as companies who provide this type of healthcare have recently worked to make a name for themselves. Services such as CareClix, ConsultADoctor, and Teladoc are just a few of these providers who utilize […]
The results of the 2018 primary election have officially been tabulated and the impact that will be made on healthcare law is slowly becoming clear. The most notable healthcare development is in regards to the Affordable Care Act (ACA) that was enacted in March of 2010 under President Obama, the primary goal of which was […]
On November 1, 2018, the United States District Court for the District of Columbia issued a Memorandum Opinion, ordering the Medicare appeals backlog to be eliminated by FY 2022. Specifically, the court ordered that the Department of Health and Human Services (HHS) achieve the following reductions from the current backlog of 426,594 pending appeals: – […]
In the FY 2015 IPPS/LTCH proposed rule (79 FR 28169) and final rule (79 FR 50146), CMS discussed and then implemented Section 2718(e) of the Public Health Service Act, which was enacted as part of the Affordable Care Act. The rule aimed to improve the transparency of hospital charges by requiring hospitals to either post […]
Medicare officials are investigating pharmacies that sell compounding made-to-order gels, lotions, and creams for possible fraud and patient safety risks. In general, made to order creams used in pain treatments can dramatically improve a patient’s quality of life, but HHS regulators are concerned for patient safety if these drugs are not properly monitored. For example, […]
On Thursday, August 2, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its 2019 Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (the “2019 IPPS Final Rule”).[1] With the goal to reduce unnecessary administrative burden on physicians and other qualified practitioners, the 2019 IPPS Final Rule revises the […]
The National Guideline Clearinghouse (NGC) website, “guideline.gov,” compiles the latest information on medical treatment for use by healthcare organizations, physicians, bulk purchasers, educational institutions, and state and local governments, while also providing guidance on medications and procedures ranging from miniscule to critical. The NGC contains over 20 years of evidence-based clinical practices and medical guidelines, […]
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