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Medicaid › Medi-Cal

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Troutman Pepper Locke

California AG Takes Action Against $1.3 Million Insurance Fraud Scheme

Troutman Pepper Locke on

In May, California’s attorney general (AG) charged a local dermatologist with more than 20 counts of fraud after uncovering a scheme that allegedly resulted in the state’s Medicaid program paying out over $1.3 million for...more

Fennemore

California’s Bold Experiment with Whole-Person Centered Care: Has it Worked?

Fennemore on

CalAIM is an initiative of the California Department of Health Care Services (the Department) to improve the quality of life and health outcomes of Medi-Cal members by implementing delivery system, program, and payment...more

Foley & Lardner LLP

FQHCs: Medicaid Litigation Year in Review

Foley & Lardner LLP on

Recent federally qualified health center (FQHC) litigation highlights the impact state Medicaid agencies have on FQHC reimbursement. The important decisions summarized below all involve FQHC disputes over state Medicaid...more

Weintraub Tobin

California Medi-Cal Enrollment Appeals: An Uphill Battle but an Essential Tool

Weintraub Tobin on

In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more

Cozen O'Connor

Centene to Pay $215 Million to California over Medicaid Overbilling Allegations

Cozen O'Connor on

California AG Rob Bonta settled with pharmacy benefit manager (PBM) Centene Corporation and its subsidiaries in connection with alleged overcharges by Centene to California’s Medi-Cal program....more

Cozen O'Connor

The State AG Report – 2.9.2023

Cozen O'Connor on

Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •AG James Settles over Sale of Unlawful Monitoring Software-...more

Cozen O'Connor

Online Pharmacy Start-up Settles with AG Bonta for $15 Million over Alleged Medi-Cal Fraud

Cozen O'Connor on

California AG Rob Bonta settled with Hey Favor, Inc. and affiliated and predecessor entities that previously conducted business as “The Pill Club” for allegedly violating the California False Claims Act by knowingly...more

Foley & Lardner LLP

Episode 22: CalAIM: Addressing Whole Person Care in California

Foley & Lardner LLP on

In this episode, Foley partner Anil Shankar discusses California’s new Medicaid wavier called CalAIM, (California Advancing and Innovating Medi-Cal, the multiyear care delivery and payment reform initiative led by the...more

Harris Beach Murtha PLLC

Summary of Fraud and Abuse Enforcement Yields Insight for Health Care Compliance and Risk Assessment

Harris Beach Murtha PLLC on

The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based...more

King & Spalding

CMS Approves CalAIM proposal to transform California’s Medi-Cal

King & Spalding on

On December 29, 2021, the California Department of Health Care Services (DHCS) announced CMS’s approval of its California Advancing and Innovating Medi-Cal (CalAIM) proposal. CalAIM’s launch on January 1, 2022 is part of a...more

Sheppard Mullin Richter & Hampton LLP

Medi-Cal Rx: California to Transition Medi-Cal Pharmacy Benefits to Fee-For-Service

Sheppard Mullin Richter & Hampton LLP on

On April 1, 2021, the California Department of Health Care Services (“DHCS”) will be transitioning all Medi-Cal pharmacy benefits from managed care to fee-for-service (“FFS”). This new system to administer FFS pharmacy...more

McDermott Will & Schulte

New Laws Expand Telehealth in California

McDermott Will & Schulte on

California Governor Gavin Newsom recently signed into law two bills that expand the delivery of telehealth services in the state. In particular, the legislation: • Permits providers to prescribe medications without a...more

Sheppard Mullin Richter & Hampton LLP

California Expands Medicaid Tele-Health Policy

Sheppard Mullin Richter & Hampton LLP on

The California Department of Health Care Services (“DHCS”) recently revised its Medi-Cal telehealth policy to allow providers increased flexibility in their use of telehealth as a modality for delivering medically necessary...more

Brownstein Hyatt Farber Schreck

Expansion of Medicaid Eligibility for Undocumented Young Adults

Brownstein Hyatt Farber Schreck on

In recent weeks, the states of California and Washington, and New York City have proposed expanding Medicaid eligibility for undocumented young adults. Given Medicaid’s combination of state and federal funding, House and...more

Mintz - Health Care Viewpoints

A Rundown of Recent State Action Relating to Medicaid Expansion

Mintz - Health Care Viewpoints on

To date, 34 states (including D.C.) have adopted Medicaid expansion. Of the remaining 17 states, some are considering expanding Medicaid. States with recent activity relating to Medicaid expansion include Florida, Idaho,...more

Sheppard Mullin Richter & Hampton LLP

In Case Alleging Nationwide Pharmacy Fraud, Kmart Scores Narrow Settlement

Sheppard Mullin Richter & Hampton LLP on

As described in an April 17, 2018 article originally posted on the Sheppard Mullin Richter and Hampton, LLP False Claims Act Defense Blog, Kmart Corporation and the U.S. Department of Justice entered into a False Claims Act...more

Buchalter

California Court Endorses Percentage Billing Fees for Medi-Cal Providers

Buchalter on

California’s First District Court of Appeal (“Court of Appeal”) has recognized that percentage-based billing arrangements do not violate California’s Medi-Cal laws and that the California Department of Health Care Services...more

Herbert Smith Freehills Kramer

California Court Upholds Expansive Definition of Recoupment

Herbert Smith Freehills Kramer on

The Bankruptcy Court for the Central District of California examined the scope of the doctrine of recoupment for Medicaid and related payments, allowing the deduction by the state. The court held that the California...more

King & Spalding

CMS Grants California’s Request for Five-Year Medicaid Waiver

King & Spalding on

On December 30, 2015, CMS approved California’s request for a five-year waiver to extend California’s Section 1115(a) demonstration project, entitled “California Medi-Cal 2020 Demonstration.” According to the CMS approval...more

Foley & Lardner LLP

CMS Approves California’s Section 1115 Medicaid Demonstration

Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) has approved a new section 1115 Medicaid demonstration for the state of California. Under the demonstration, the California Department of Health Care Services (DHCS) will...more

Baker Donelson

CMS Prevails in Dual Eligible Bad Debt Challenge

Baker Donelson on

In a decision handed down on August 7, 2015, the United States Court of Appeals for the District of Columbia Circuit upheld the denial of the providers' bad debt claims associated with dual eligible beneficiaries. Grossmont...more

Epstein Becker & Green

Supreme Court Rules That Providers and Suppliers Cannot Challenge Medicaid Reimbursement Rates in Federal Court

Epstein Becker & Green on

On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more

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