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14 Aug 2023, 10:00 am
A wide range of Medicare Part-B providers and suppliers are eligible to participate, with the exception of durable medical equipment and laboratory suppliers. [read post]
14 Aug 2023, 7:13 am
[2] Centers for Medicare & Medicaid Services, Spotlight: Physician-Owned Hospital Expansion Exception Requests – Changes Effective October 1, 2023, available at https://www.cms.gov/medicare/fraud-and-abuse/physicianselfreferral/spotlight (last accessed August 2, 2023) [read post]
5 Jul 2023, 5:46 am
On June 6, 2023, the Center for Medicare and Medicaid Services (“CMS”) released a Quality Safety & Oversight memorandum (“QSO Memo”) reminding state survey agencies, accrediting organizations, and hospitals of the requirements for discharges and transfers to post-acute care (“PAC”) providers. [read post]
28 Jun 2023, 6:53 am
HHSC-OIG regularly conducts investigations and audits of Medicaid claims submitted by providers and suppliers and has the authority to prosecute individuals or entities involved in Medicaid fraud. [read post]
20 Jun 2023, 5:55 am
" (Emphasis added).[9] November 5, 2021 - CMS Vaccine Mandate: CMS issued an Interim Final Rule revising the requirements that most Medicare and Medicaid certified providers, and associated suppliers must meet to participate in the Medicare and Medicaid programs. [read post]
29 May 2023, 10:00 am
Medicare Advantage Plans are Aggressively Denying Claims – Administrative Appeals are Growing (May 25, 2023): According to the latest data released by the Centers for Medicare and Medicaid Services (CMS), beneficiaries participating in Medicare Advantage[1] plans now surpass those enrolled in original Medicare plans. [read post]
8 May 2023, 12:28 am
States also have the administrative authority to bar providers from participating in their State Medical Assistance Programs (primarily Medicaid and CHIP).[5] Medicaid exclusion actions[6] are similar to OIG exclusions in many respects, but there are also important differences. [read post]
1 May 2023, 5:19 pm
Section 1128A(a)(5) of the anti-kickback statute provides for the imposition of civil monetary penalties against any person who offers or transfers remuneration to a Medicare or State health care program (including Medicaid) beneficiary that the benefactor knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of any item or service for which payment may be made, in whole or in part, by… [read post]
11 Apr 2023, 11:05 am
Many Medicare Advantage plans include prescription drug coverage, which can be convenient for patients who take multiple medications. [read post]
30 Mar 2023, 7:10 am
Further, there are several statements and rules from the Center for Medicaid and Medicare (CMS) which will be changing to accommodate the IRA’s provisions. [read post]
30 Mar 2023, 7:10 am
Further, there are several statements and rules from the Center for Medicaid and Medicare (CMS) which will be changing to accommodate the IRA’s provisions. [read post]
28 Mar 2023, 9:44 am
Reddy’s, Intas Pharmaceuticals, or BDR Pharmaceuticals), to supply patients purchasers through the Federal Supply Schedule, as well as the Medicare and Medicaid programs. [read post]
16 Mar 2023, 10:27 am
Medicare, Medicaid, and private health insurance companies have a list of approved services and medications that are seen as medically necessary. [read post]
9 Mar 2023, 11:20 am
Of these patients, 6 were Medicare beneficiaries and 32 were Medicaid beneficiaries. [read post]
1 Mar 2023, 12:35 pm
Medicaid.Numotion is a national supplier of durable medical equipment (DME), such as hospital beds, manual wheelchairs, power wheelchairs and accessories, and gait trainers. [read post]
22 Feb 2023, 7:17 am
The Centers for Medicare & Medicaid Services (CMS) recently issued a Medicare-related final rule invoking the agency’s statutory authority to promulgate retroactive rules after finding that failure to apply the final rule retroactively would be “contrary to the public interest. [read post]
10 Feb 2023, 9:25 am
Indeed, of the more than $2.2 billion in FCA settlements and judgments reported by DOJ, over $1.7 billion (more than 80 percent of all recoveries) related to matters that involved the health care and life sciences industries, including drug and device manufacturers, durable medical equipment suppliers, home health and managed care providers, hospitals, pharmacies, hospice organizations, and physicians. [read post]
7 Feb 2023, 6:19 pm
These recoveries restore funds to federal programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families. [read post]
12 Jan 2023, 9:05 pm
” The Centers for Medicare and Medicaid Services (CMS) announced its plan to implement a Medicare drug pricing negotiation program, which will set maximum fair price ceilings, as authorized by the Inflation Reduction Act. [read post]
19 Dec 2022, 1:55 pm
Three consolidated False Claims Act ("FCA") lawsuits against chiropractor Yury Gampel ("Gampel"), 15 Modern Vascular office-based labs owned primarily by Gampel located across the United States, and five Modern Vascular-affiliated companies owned by Gampel alert other chiropractic, physician and other medical providers using office-based labs send a clear warning to other health care providers and suppliers for services covered or billed to Medicare,… [read post]
