Hall Render

JULY 25, 2023

The settlement arose out of a case initially filed in 2015 by a whistleblower who worked at the hospital involved in the settlement. Hall Render blog posts and articles are intended for informational purposes only. Special thanks to Antoine Neumann, summer associate, for his assistance with the preparation of this article.

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Hall Render

AUGUST 1, 2022

The OPPS Proposed Rule also discusses quality-reporting requirements for REHs, an expedited Medicare enrollment process and REH-specific Stark Law updates. Hospitals may only convert to REHs if they were a CAH or rural hospital with not more than 50 beds participating in Medicare as of December 27, 2020. REH Enrollment Process.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Hall Render

DECEMBER 5, 2022

The Centers for Medicare and Medicaid Services (“CMS”) published a recent Memo reminding hospitals and other Medicare certified health care entities of their regulatory obligation to maintain a safe setting for patients, residents and staff. Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

JANUARY 21, 2022

In 2015, the plaintiff’s application for reappointment and for medical staffing privileges was rejected by the Hospital. Specifically, the physician plaintiff reported that Hospital’s employees allegedly submitted fraudulent Medicare claims. Hall Render blog posts and articles are intended for informational purposes only.

Hospitals 40

Hospitals Medicare Medicare Governance 40

Hall Render

MAY 2, 2022

CMS released data on mergers, acquisitions and changes of ownership involving hospitals and SNFs enrolled in Medicare. AHCA/NCAL published a report on SNF closure data stating that more than 1,000 SNFs have closed since 2015. Hall Render blog posts and articles are intended for informational purposes only.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

MedTrainer

MARCH 3, 2021

The Physician Quality Reporting System (PQRS) was first introduced over a decade ago by the Centers for Medicare and Medicaid Services (CMS) as a quality reporting program. In 2015, the reporting program shifted from a voluntary program to a mandatory one in which penalties would be assessed for failure to participate.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Provider Trust

JULY 26, 2023

The Centers for Medicare and Medicaid Services (CMS) conducted multiple reviews of Medicaid Advantage provider directories between February 2016 and July 2018. Their report from the third round of reviews found that of the 108 providers selected from 52 Medicare Advantage Organizations (MAO) directories, 48.7%

Medicaid 52

Medicaid Medicaid Compliance Medicare 52

Healthcare Blog

AUGUST 23, 2023

Resources Available to Help Healthcare Organizations Promote Ethical Behavior The Centers for Medicare and Medicaid Services has many policies, procedures, and legislation on ethical standards in healthcare. link] Centers for Medicare & Medicaid Services. Retrieved July 16, 2023, from [link] Castel, E.S., Ginsburg, L.R.,

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Health Populi

JUNE 13, 2018

The point here is that the share of employee earnings devoted to healthcare has grown: workers have traded off wage increases for healthcare benefits, a central theme over the ten+ years that I’ve written this blog. Watch this space, and this blog, for continued focus on financial wellness, healthcare costs, and consumer sentiment.

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Medicaid Medicaid Health Insurance Medicare 63

Verisys

NOVEMBER 14, 2023

Many healthcare organizations find themselves in a merger and suddenly serve more providers than their staff can handle. If your organization is ready to streamline and shorten your credentialing timeline, reach out today.

Licensing 52

Licensing Medicaid Medicaid Governance 52

CMS.gov

AUGUST 23, 2018

CMS BLOG [link]. Note: 2014 data was as of 5/27/14, 2015 was as of 11/03/14, 2016 was as of 10/29/15, 2017 was as of 11/05/16, 2018 was as of 11/07/17. Note: 2015 enrollment was as of 5/6/15, 2016 enrollment was as of 8/22/16, 2017 enrollment is as of 5/31/17 , and 2018 enrollment is as of 12/23/17. Thu, 08/23/2018 - 12:29.

Health Insurance 42

Health Insurance Medicare Medicare 42

Healthcare Law Blog

NOVEMBER 21, 2022

22-19 (the “Advisory Opinion”), which declared that a charitable organization funded by manufacturers would violate the AKS if it offered certain cost-sharing subsidies under Medicare Part D (“Part D”), even if the organization was independently run and patients had equal access to discounts for 90% of drugs on the market. 2, 2015). [10]

Medicare 52

Medicare Medicare Governance Medicaid 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). 1] Kaiser Family Foundation, Medicaid Postpartum Coverage Extension Tracker (Mar. 31, 2022). [2]

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Medicaid Medicaid ACA Public Health 52

Provider Trust

MAY 18, 2022

Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Provider Trust

JULY 26, 2022

This resulted in the practice submitting at least $147,000 in fraudulent claims for reimbursement to Medicare and numerous private insurance companies. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud.

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Licensing Fraud Compliance Nurses 52

Healthcare Law Blog

MAY 16, 2022

In December 2021, the Centers for Medicare & Medicaid Services (CMS) approved the California Department of Health Care Services’ (DHCS’) request for a five-year extension of its Medicaid section 1115 demonstration and a five-year extension of its Medicaid managed care section 1915(b) waiver.

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Health Law RX

JULY 18, 2023

This partnership will involve, among other things, referring violations to other agencies for other regulatory considerations, such as the HHS Office for Civil Rights, the Federal Trade Commission, the Centers for Medicare and Medicaid Services, or the Department of Justice. What would such collaboration look like?

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Fraud Compliance Medicaid Medicaid 52

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS recognizes a need to smooth these transitions and help to ensure stability in Medicare payments.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Drug & Device Law

DECEMBER 29, 2023

2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. This year’s Drug & Device Law Blog top ten decisions of the year reinforced preemption – the most powerful defense we can assert. If any of these are your cases, the Blog congratulates you. Executive Health Resources, Inc. ,

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FDA US Department of Health and Human Services COVID-19 Informed Consent 105

Drug & Device Law

JANUARY 30, 2023

For those of you accessing the Blog on mobile devices, this post may be hard to read. Plaintiffs Legal Committee , 531 U.S. 341 (2001), with the rejection of the so-called “purposes and objectives” prong of implied preemption by the most conservative justices (at least in terms of federalism) on the Court. Walsh , 538 U.S. Maretta , 569 U.S.

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FDA Fraud Governance Medicare 72

Drug & Device Law

NOVEMBER 9, 2023

In addition to its recent revamp of its “§510(k)” substantial equivalence clearance process for medical devices, (see our post here ), the FDA has also been active with respect to off-label communications – another regulatory area of continuing interest to this Blog. Caronia , 703 F.3d 3d 149 (2d Cir. 2012); Amarin Pharma, Inc. FDA , 119 F.

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