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2 May 2024, 8:08 am
Becerra 23-715Issue: Whether the phrase “entitled … to benefits,” used twice in the same sentence of the Medicare Act, means the same thing for Medicare part A and Supplemental Social Security benefits, such that it includes all who meet basic program eligibility criteria, whether or not benefits are actually received. [read post]
2 May 2024, 5:54 am
This morning, CMS published a 700-page proposed rule to revise the Medicare hospital inpatient prospective payment systems. [read post]
2 May 2024, 12:18 am
For future medical needs, you may also need to set aside a portion of your workers’ compensation income, assuming you are eligible for Medicare. [read post]
1 May 2024, 1:18 pm
Evolution of AKS-Based FCA Case Law The AKS is a criminal statute that makes it a felony to knowingly and willfully offer or accept remuneration in return for inducing or rewarding patient referrals or the generation of business covered by federal programs like Medicare and Medicaid.[7] Starting in the 1990s, violations of the AKS by hospitals and drug manufacturers became a common predicate for civil liability under the FCA in cases brought by the DOJ and qui tam relators. [read post]
1 May 2024, 12:17 pm
One of the most significant non-monetary advantages is health insurance through Medicare, which is available to SSD recipients after a designated waiting period. [read post]
30 Apr 2024, 12:15 pm
UPDATE to previous posts (here and here) on the Medicare Drug Price Negotiation Program in the Inflation Reduction Act. [read post]
29 Apr 2024, 9:36 am
Not every facility that is eligible to accept Medicare or Medicaid does. [read post]
29 Apr 2024, 4:00 am
But when non-state parties such as the hospitals in the Idaho case accept Medicare funding, the state is not agreeing to anything. [read post]
27 Apr 2024, 1:00 am
You really can't blame Big Pharma for hating the new federal law that authorizes the Medicare program (for the first time in its 59-year existence) to stop buying drugs for the manufacturer's price but instead to negotiate for a reasonable price (the way the VA, state Medicaid agencies, the Defense Department, and most other countries do).Medicare has been a predictably incredible cash cow for [read post]
25 Apr 2024, 11:19 pm
The hospital is set to be removed from the Medicare program by April 30 after the Center for Medicare and Medicaid Services determined it was out of compliance with nine requirements. [read post]
25 Apr 2024, 9:30 pm
The Centers for Medicare and Medicaid Services (CMS) announced a final rule that creates minimum nurse staffing requirements for long-term care (LTC) facilities that receive Medicare and Medicaid funding. [read post]
25 Apr 2024, 4:49 am
” EMTALA sets conditions for hospitals to receive Medicare funds and mandates that hospitals have to “stabilize” patients with emergency conditions in hospitals. [read post]
Supreme Court Hears Arguments on Whether Federal Emergency Treatment Law Preempts State Abortion Ban
24 Apr 2024, 9:20 pm
The case poses the question of whether the federal Emergency Medical Treatment and Labor Act that requires hospitals accepting Medicare to provide stabilizing emergency treatment to patients preempts state abortion bans when such treatment would involve pregnancy termination. [read post]
24 Apr 2024, 12:45 pm
ShareThe Supreme Court on Wednesday was divided over whether a federal law requiring hospitals that participate in Medicare to provide “necessary stabilizing treatment” in an emergency overrides an Idaho law that bars most abortions. [read post]
24 Apr 2024, 9:06 am
Sanders has introduced the Medicare for All Act which would create an Office of Health Equity that is focused on better tracking, addressing, and preventing health disparities. [read post]
24 Apr 2024, 4:52 am
Calculation of Medicare Drug Average Sales Price Medicare pays for some separately payable Medicare Part B-covered drugs and biologics using the average sales price (ASP) methodology. [read post]
24 Apr 2024, 1:52 am
Nearly all hospitals accept Medicare. [read post]
23 Apr 2024, 9:05 pm
Failure to comply with EMTALA can lead to patient lawsuits for damages, civil monetary penalties of up to nearly $130,000 per violation, and a medical facility’s potential exclusion from participation in Medicare. [read post]
23 Apr 2024, 1:32 pm
This is particularly true given the stakes of the Biden administration’s interpretation: Medicare spending in Idaho, where one in five residents is enrolled in the program, was $3.4 billion in the two-year period between 2018 and 2020, while annual Medicare spending in 2022 was nearly a trillion dollars. [read post]
HHS Inspector General Reiterates Commitment to Combating Healthcare Fraud, Highlights Areas of Focus
23 Apr 2024, 11:57 am
” Durable Medical Equipment (DME) Fraud: DME fraud “persisted in traditional Medicare for decades and is growing in Medicare managed care. [read post]
