News Briefs - Lawmakers Reintroduce Healthcare Workforce Resilience Act - Federal lawmakers are trying again to push through immigration reform that would allow officials to recapture unused visas and reprocess them for...more
News Briefs - Google Cloud Unveils AI to Help Doctors with Search Capabilities - Google Cloud announced new artificial intelligence-powered search capabilities that it said will help healthcare workers quickly pull accurate...more
10/12/2023
/ Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
DEA ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare Workers ,
Long Term Care Facilities ,
Medicare ,
Nurses ,
Nursing Homes ,
Physicians ,
Prescription Drugs ,
Telehealth ,
Telemedicine
News Briefs - Feds Propose New Nursing Home Minimum Staffing Requirements - The nation's most thinly staffed nursing homes would be required to hire more workers under new rules proposed by the Biden administration, the...more
9/13/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Workers ,
Hospitals ,
Long Term Care Facilities ,
Medicare ,
Nursing Homes ,
Physicians ,
Popular ,
Surprise Medical Bills
News Briefs - More States Introducing 'Conscience' Healthcare Bills - A new Montana law will provide sweeping legal protections to healthcare practitioners who refuse to prescribe marijuana or participate in procedures and...more
8/9/2023
/ Cybersecurity ,
Data Breach ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Hospice ,
Manufacturers ,
Medical Devices ,
Medicare ,
Pharmaceutical Industry ,
Pharmacy Benefit Manager (PBM) ,
Physicians
News Briefs - FTC-Proposed Merger Guidelines Could Slow Healthcare Deals - Newly proposed merger guidelines from the Federal Trade Commission could chill dealmaking in the healthcare sector, as well as increase the costs and...more
8/2/2023
/ Data Breach ,
Data Privacy ,
Federal Trade Commission (FTC) ,
Hospice ,
Hospitals ,
Medicare ,
Mergers ,
Nursing Homes ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Price Transparency ,
Telehealth
News Briefs - High Court Rules Residents Can Sue Publicly Owned Nursing Homes - The U.S. Supreme Court preserved the ability of people to sue for civil rights violations under an 1871 law as it rejected a bid to prevent an...more
News Briefs - Debt Limit Deal Will Claw Back $27.1B in Unspent COVID Funding - President Joe Biden signed a debt limit deal that includes some minimal cuts for healthcare programs just days before the federal government was...more
The financial stakes are often very high for providers when statistical sampling and extrapolation is used to calculate an alleged Medicare overpayment. In post-payment audits involving extrapolation, an actual claims denial...more
Between 2006 and 2014, affiliated long-term care hospitals and a skilled nursing facility (“the Providers”) provided covered services to patients who were eligible for both Medicare and Medicaid (“dual-eligible...more
CMS Announces Hospice Capitation Rates for Medicare Advantage -
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design...more
On July 9, 2018, in United States ex rel. Polukoff v. St. Mark’s Hosp., the Tenth Circuit Court of Appeals added to the debate over the role of the False Claims Act in policing medical necessity. ...more
Medicare’s implementation of post-payment review through overly aggressive zone program integrity contractors (ZPICs) and unified program integrity contracts (UPICs), combined with an ineffective review process at the first...more
Medicare’s implementation of post-payment review through overly aggressive private contractors, combined with an ineffective review process at the first two levels of the administrative appeal process (redetermination and...more
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on April 27, 2018 to overhaul the payment system for skilled nursing facilities (SNFs). Specifically, the rule would “update the payment rates used...more
Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with an ineffective review process at the first two levels of administrative appeal...more
On January 11, 2018, the United States District Court for the Middle District of Florida set aside a nearly $350 million False Claims Act (FCA) jury verdict rendered in February 2017 against a group of fifty-three skilled...more
Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more
11/11/2015
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Hospice ,
Medicare ,
Medicare Provider Agreements ,
OMHA ,
RAC Audits ,
Recoupment ,
Recovery Audit Contractors (RACs)
As you likely are aware, Medicare hospice payments were reduced by two percent in accordance with a sequestration order issued March 1, 2013, pursuant to Section 251A of the Balanced Budget and Emergency Deficit Control Act....more