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Showing 62 posts in Medicare.

An Unlikely Consequence

October 22, 2013
Posted In Affordable Care Act, Affordable Insurance Exchanges, Health Care Law, Hospitals, Medicare

The Affordable Care Act (“ACA”) took a big leap forward this month with the opening of the federally-facilitated and state-operated Exchanges. Here in Kentucky, 70,467 people reportedly participated in pre-screenings to determine qualifications for subsidies, discounts, or programs like Medicaid on the Health Insurance Exchange’s first enrollment day, October 1, 2013. The ACA is eventually expected to provide health coverage to as many as 30 million additional Americans. So, why are hospitals across the nation slashing jobs? More >

The Pioneer Program Report Card

August 6, 2013
Posted In Accountable Care Organizations (“ACO”), Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Medicare Shared Saving Program (MSSP), Patient Protection and Affordable Care Act (“ACA”)

In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization (“ACO”) program created through the Affordable Care Act (“ACA”).  The program’s goals were to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity. More >

Proposed Payment Changes for Medicare Home Health Agencies

July 30, 2013
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Home Health Prospective Payment System, Low-utilization payment adjustment ("LUPA"), Medicare, Nonroutine medical supplies conversion factor (“NRS”)

The Centers for Medicare and Medicaid (“CMS”) recently released a proposed rule involving 2014 payment changes for the Home Health Prospective Payment System. The rule projects that the changes could reduce Medicare payments to home health agencies by 1.5 percent. CMS estimates that 3.5 million beneficiaries currently receive home health services, costing Medicare approximately $18.2 billion in 2012, so a 1.5 percent reduction would be significant ($290 million, to be exact). More >

Sound Inpatient’s Unsound Practices Lead to $14.5 Million Settlement

July 23, 2013
Posted In False Billings, False Claims Act, Hospitalists, Medicare, Upcoding

On July 3, 2013, the United States Department of Justice announced Sound Inpatient Physicians, Inc. (“Sound Inpatient”) will pay $14.5 million dollars to settle allegations that it over-billed Medicare and other federal health care programs. The Washington-based company employs more than 700 hospitalists and post-acute physicians to facilities in twenty-two states. More >

OIG 2013 WORK PLAN GIVES DIRECTION FOR PHYSICIANS

April 5, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), Electronic Health Records (“EHR"), Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

The government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011. Over the last four years, the administration’s enforcement efforts have recovered $14.9 billion, up from $6.7 billion over the prior four-year period.  During 2012, the Department of Justice (“DOJ”) opened 885 new civil health fraud investigations with 1,023 civil fraud matters pending at the end of the year.  The DOJ also reported a record 647 whistleblower lawsuits and recovered $3.3 billion from lawsuits filed by whistleblowers. On the criminal side, the DOJ opened 1,121 new criminal healthcare fraud investigations with 2,032 healthcare fraud criminal investigations pending at the end of FY 2012.  The DOJ filed criminal charges in 452 cases involving 892 defendants during that time. On the civil side, The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) excluded 3,131 individuals and entities from participation in the Medicare and Medicaid programs during FY 2012. As the pursuit of health fraud becomes increasingly profitable reportedly returning $7.90 for every $1 spent, providers should expect to see a continued focus and devotion of resources by the federal government to combat healthcare fraud and abuse.  Likewise, the floodgates appear to be opening for healthcare false claims cases as whistleblower suits are predicted to gain popularity as their success breeds volume increases. More >

Annual Report Details Record Breaking Success in Health Care Fraud Prevention

February 26, 2013
Posted In Abuse and Waste, Centers for Medicare & Medicaid Services (“CMS”), Compliance Programs, Department of Health and Human Services (HHS), Fraud, Health Care Fraud, Health Care Fraud and Abuse Control Program, Health Care Law, Health Insurance Portability and Accountability Act of 1996 (HIPAA), Medicaid, Medicare

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), required the establishment of a national Health Care Fraud and Abuse Control Program (“HCFAC”). The HCFAC Program is a joint Department of Justice (“DOJ”) and Health and Human Services (“HHS”) coordination of federal, state and local law enforcement activities to combat fraud committed against all health plans, both public and private. More >

Tags: Health Care Law

CMS 2014 Call Letter: A Bright Future for CMS Star Rating System

February 22, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Kentucky’s Department for Medicaid Services, Medicaid, Medicare

On February 15, the Centers for Medicare & Medicaid Services (CMS) issued the draft calendar year (CY) 2014 Call Letter for the Medicare Advantage (MA) and Part D programs (Call Letter). It contains information that MA organizations and Part D plan sponsors (collectively, Plan Sponsors) need to prepare their 2014 bids and operations. More >

Tags: Health Care Law

CMS Proposes to Change Physician Requirements for RHC's and FQHC's

February 22, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), Federally Qualified Health Centers (“FQHCs”), Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”), Rural Health Centers (“RHCs”)

Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements. More >

Tags: Health Care Law

Reforming Medicare Audits

November 8, 2012
Posted In Health Care Law, Medicaid, Medicare, Medicare Audit Improvement Act of 2012, Recovery Audit Contractors (“RAC”)

On October 16, 2012, the Medicare Audit Improvement Act of 2012[1] was introduced in the U.S. House of Representatives by Representative Sam Graves. The purpose of this legislation is to reform the Medicare auditing program. This legislation aims to improve the accuracy and transparency of Medicare audits of hospitals as well as increase the accountability of Recovery Audit Contractors (“RAC”).[2] More >

Tags: Health Care Law

Changes to Deadlines for Stage Two – Meaningful Use in the Medicare and Medicaid EHR Incentive Programs

October 25, 2012
Posted In Critical Access Hospitals (“CAHs”), Electronic Health Records (“EHR"), Health Care Law, Health Information Technology for Economic and Clinical Health Act (HITECH Act), Medicaid, Medicare

Under the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, health care professionals and hospitals may qualify for incentive payments when they adopt and meaningfully use certified electronic health records (“EHR") under a three stage process. More >

Tags: Health Care Law
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