The New York State Department of Health (NYSDOH), in its October 2020 Medicaid Update (published last week on November 2, 2020), announced that the annual December certifications (i.e., the Office of the Medicaid Inspector General (OMIG) and Deficit Reduction Act (DRA) certifications (commonly referred to as the SSL Certification and DRA Certification, respectively)) required by […]
On September 18th, a panel of the Fifth Circuit affirmed a lower court ruling denying injunctive relief against recoupment for Medicare providers still faced with an overpayment demand after going through the first two steps of the administrative review process. In affirming the lower court’s decision, the Fifth Circuit affirmed that the government had provided […]
The Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) recently released the Health Care Fraud and Abuse Control Program Annual Report for 2019 (the “Report”). The Report provides an overview of the joint effort of the HHS and DOJ in identifying and prosecuting health care fraud in Fiscal Year 2019. […]
The Department of Labor (DOL) recently issued a temporary rule (the “Revised Rule”) that revised the regulations implementing the Families First Coronavirus Response Act (“FFCRA”). These revisions went into effect on September 16, 2020. By way of background, the FFCRA created two new emergency paid leave requirements, the Emergency Family and Medical Leave Expansion Act […]
The U.S. Department of Health and Human Services Office of Inspector General (OIG) has recently issued a report regarding overpayment reviews by Medicare Administrative Contractors (MACs). The OIG’s report determined that MACs have been inconsistent in reviewing extrapolated overpayments during the provider appeals process. These inconsistencies have resulted in at least $42 million in extrapolated […]
On August 3, 2020, two issues were approved for review and posted on the Centers for Medicare & Medicaid Services (CMS) Recovery Audit program website: 0184 – Total Hip Arthroplasty: Medical Necessity and Documentation Requirements, and 0185 – Total Knee Arthroplasty: Medical Necessity and Documentation Requirements. In particular, the approved issues involve whether the documentation […]
The Office of Medicare Hearings and Appeals (OMHA) has recently opened the Settlement Conference Facilitation (SCF) to the appellant community. The SCF is an alternative dispute resolution (ADR) process meant to bring certain providers and the Centers for Medicare & Medicaid Services (CMS) together to discuss mutually agreeable resolutions for Medicare Part A and B […]
The Centers for Medicare and Medicaid Services (CMS) has issued two new proposed rules. First, CMS has issued a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS Proposed Rule). The rule will be published on August 17, 2020. You can access the unpublished version here. Second, CMS issued a proposed rule for the […]
Recently, the Small Business Administration (SBA) issued guidance regarding loan forgiveness for the Paycheck Protection Program (PPP). In its guidance, the SBA details the PPP loan forgiveness process and reiterates certain rules and requirements for PPP loan forgiveness. We discussed the PPP loan forgiveness rules and requirements in a prior post, available here. Below is […]
The Department of Health and Human Services (HHS) has issued new FAQs regarding how Provider Relief Fund (PRF) payments may be spent and when recipient-providers must report their use of funds. Under the Terms/Conditions that apply to recipients of PRF funds, each provider is required to have a written policy or written procedures to govern […]
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