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Medicaid › Penalties

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 -
Haynes Boone

False Claims Act - 2025 Mid-Year Review

Haynes Boone on

The False Claims Act continues to be one of the most commonly used weapons in the government’s enforcement arsenal to address various forms of fraud. In addition to our “Year in Review” publication providing an overview of...more

Rivkin Radler LLP

DOJ and HHS Announce FCA Working Group

Rivkin Radler LLP on

On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance...more

Stotler Hayes Group, LLC

Avoiding Transfer Penalties: How to Identify Successful Strategies to Remove Penalties on Medicaid Eligibility for the Skilled...

Stotler Hayes Group, LLC on

Medicaid is the primary payer for 63% of nursing facility residents, propping up a large part of the industry’s funding. ...more

Holland & Hart LLP

FMV for Provider Contracts: Regulatory Standards

Holland & Hart LLP on

As a general rule, healthcare employers are required to pay employed physicians and other contracted providers fair market value (FMV) for their services, but many employers do not understand relevant regulatory standards. ...more

Mandelbaum Barrett PC

Medicaid Final Agency Decision Reaffirms Criteria Necessary to Qualify for Caregiver Child Exception

Mandelbaum Barrett PC on

Certain Medicaid programs impose a transfer penalty on applicants who have transferred resources (assets) for less than fair market value within five (5) years preceding the Medicaid application. Simply stated, the transfer...more

ArentFox Schiff

Investigations Newsletter: Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme

ArentFox Schiff on

Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme - The Chicago-based owner of two laboratories, Zoom Labs Inc. and Western Labs Co., has been charged with health care fraud...more

Mandelbaum Barrett PC

Medicaid Alert: Changes to Medicaid’s Penalty Divisor Effective April 1, 2024

Mandelbaum Barrett PC on

Beginning April 1, 2024, the State of New Jersey will increase the Medicaid penalty divisor to $440.10 per day, as compared to the previous penalty divisor of $384.57 in 2023. See Medicaid Communication No. 24-03....more

Lippes Mathias LLP

New York State Medicaid Updates for 2024

Lippes Mathias LLP on

Medicaid is a joint federal and state program that provides health coverage to millions of Americans. Federal law requires states to comply with certain minimum requirements, but New York is considered a maximum state in that...more

Harris Beach Murtha PLLC

New York Medicaid Inspector General’s Office Posts Compliance Program FAQS

Harris Beach Murtha PLLC on

On September 21, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) posted on its website Compliance Program Requirements Frequently Asked Questions. OMIG intends the FAQs to supplement its Compliance...more

King & Spalding

CMS Announces Increased Scrutiny for Poor-Performing Nursing Facilities

King & Spalding on

On October 21, 2022, CMS announced new actions to increase accountability and scrutiny on nursing homes in the Special Focus Facilities Program (SFF Program), an oversight program for the poorest performing nursing homes in...more

Mintz - Health Care Viewpoints

With Proposal to Cap Drug Price Increases, Massachusetts Once Again Takes Center Stage in the Drug Pricing Debate

Mintz - Health Care Viewpoints on

On March 17, the same day we wrote about proposed legislation in Connecticut to cap drug price increases, Governor Charlie Baker of Massachusetts included a similar proposal in his proposed budget. Similar to the Connecticut...more

Flaster Greenberg PC

Medicaid Caregiver Child Exemption Success Story in New Jersey: Home Saved & Nursing Home Paid

Flaster Greenberg PC on

Flaster Greenberg’s seasoned elder law attorney, Jane M. Fearn-Zimmer, obtained a landmark Medicaid Final Agency Decision for her elderly, ailing client and her family after a three-year long dispute with the New Jersey...more

Dorsey & Whitney LLP

Significant Changes in Healthcare Laws Enacted Through the Bipartisan Budget Act of 2018: Stark, Civil and Criminal Penalties,...

Dorsey & Whitney LLP on

On February 9, President Trump signed the Bipartisan Budget Act of 2018 (“BBA”) into law. The BBA funds the federal government through March 23 and included a bipartisan agreement to increase annual spending authority for a...more

Foley & Lardner LLP

Senate Releases Repeal and Replace Legislation on ACA: The Better Care Reconciliation Act of 2017

Foley & Lardner LLP on

After weeks of secrecy, the Senate has released a discussion draft of legislation that is the counterpart of the American Health Care Act (AHCA) previously passed by the House. The Senate legislation, entitled the Better Care...more

Bass, Berry & Sims PLC

The Better Care Reconciliation Act: Similarities to House Health Care Bill, Preserves Parts of ACA

Bass, Berry & Sims PLC on

On June 22, 2017, Senate Republicans released a draft of the Better Care Reconciliation Act (BCRA), their much-anticipated version of the legislation to "repeal and replace" the Affordable Care Act (ACA). Despite rumors of a...more

Bass, Berry & Sims PLC

Key Provisions of the American Health Care Act

Bass, Berry & Sims PLC on

On March 6, 2017, Republicans in the House of Representatives unveiled two bills that aim to repeal and replace the 2010 Patient Protection and Affordable Care Act (ACA). The bills, collectively called the American Health...more

Carlton Fields

MACRA: Top 10 FAQs

Carlton Fields on

Significant changes to the Medicare payment system are underway. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is set to take effect January 1, 2017. MACRA represents a deliberate departure by the...more

Chambliss, Bahner & Stophel, P.C.

The Hardship Exception to the Medicaid Penalty Period: Rare But Possible

Chambliss, Bahner & Stophel, P.C. on

If you transfer assets within five years of applying for Medicaid, you will likely be subject to a period of ineligibility. There is an exception, however, if enforcing the penalty period would cause the applicant an "undue...more

King & Spalding

November and December 2015 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

King & Spalding on

Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties. To avoid such...more

King & Spalding

CMS Proposes Sweeping Changes to Medicare Reimbursement for Clinical Diagnostic Laboratory Tests

King & Spalding on

First Data Collection Period for Clinical Laboratories Is July 1, 2015 to December 31, 2015 - In the October 1, 2015 Federal Register, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule...more

Dickinson Wright

New CMS Proposed Rule Provides Who/What/When for Clinical Laboratory Reporting Requirements Starting January 1, 2016

Dickinson Wright on

Clinical laboratories will see significant changes to their Medicare payments for clinical diagnostic laboratory tests (CDLTs) starting January 1, 2017, but the basis for new payment rates will come from “applicable data”...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - August 2015

Proskauer Rose LLP on

Editor's Overview - As the summer draws to a close, this month's Newsletter previews three cases that the U.S. Supreme Court already has agreed to hear that ought to be of particular interest to ERISA plan sponsors and...more

Chambliss, Bahner & Stophel, P.C.

Medicaid's Gift to Children Who Help Parents Postpone Nursing Home Care

Chambliss, Bahner & Stophel, P.C. on

In most states, transferring your house to your children (or someone else) may lead to a Medicaid penalty period, which would make you ineligible for Medicaid for a period of time. However, there are circumstances in which...more

Williams Mullen

DHHS Blunder Could Cost Millions! “Oops I Did It Again!”

Williams Mullen on

We can add one more “oops” to the Department of Health and Human Services (DHHS) repertoire of “oopses.” I am reminded of Captain Edward Smith when he banged the Titanic into an iceberg. Talk about an “oops” moment. Not to...more

Baker Donelson

2013 Healthcare Fraud and Abuse Bootcamp Webinar Series, Part V: Compliance

Baker Donelson on

Bill Mathias of Ober|Kaler's Health Law Group presented on compliance as a part of the 2013 Healthcare Fraud and Abuse Bootcamp Webinar Series sponsored by the American Health Lawyers Association. This webinar...more

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