Articles Posted in Medicare/Medicaid

On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it is expanding its Accelerated and Advance Payment Program for healthcare providers and suppliers participating in Medicare. CMS is expanding the program to ensure that all Medicare-participating providers and suppliers have the resources necessary to combat COVID-19. Accelerated and/or advance payments […]

The Centers for Medicare and Medicaid Services (CMS) has issued a Frequently Asked Questions (FAQs) Sheet responding to eight (8) FAQs regarding provider burden relief for COVID-19. Below is an overview of the FAQs Sheet issued by CMS. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health emergency (PHE) period for […]

On March 21, 2020, the New York Department of Health (DOH) published guidance in the New York State Medicaid Update March 2020 Special Edition Vol. 36, No. 5 (the “Guidance”) regarding the expansion of telehealth in response to COVID-19. The DOH’s Guidance expands telehealth to better protect Medicaid members from potential contact with sick individuals. […]

“We serve patients poorly when government regulations gather dust in the attic: they become even more stale and liable to wreak havoc throughout the health care system. Administrative costs are driving up the cost of health care in America – to the tune of hundreds of billions of dollars. The Stark proposed rule is an […]

By Adrienne Dresevic, Esq. and Carey Kalmowitz, Esq. of The Health Law Partners, P.C. The Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the agency’s ability to stop fraud by barring unscrupulous providers out of federal health insurance programs. This rule is unlike past rules in that it stops providers […]

An Ashland, KY addiction treatment specialist, Dr. Rose O. Uradu, and her substance abuse treatment center, Ultimate Care Medical Services, LLC d/b/a Ultimate Treatment Center, have agreed to pay $1.4 million to resolve civil allegations that they violated the Controlled Substances Act, and defrauded the Medicare and Kentucky Medicaid programs. The settlement resolved a civil […]

In the recently released CY 2020 Outpatient Prospective Payment System (OPPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) introduced policies that, if finalized, would require hospitals to post a list of standard charges for items and services provided. This proposed rule updates the requirements set forth in the FY 2015 Inpatient Prospective […]

On July 30, 2019, a federal jury in Detroit, Michigan, found a patient recruiter guilty for his role in a scheme involving approximately $1.3 million in fraudulent Medicare claims for home health care that were procured through the payment of illegal kickbacks. Following a six-day trial, Dominic Trumbo, 45, of Lexington, Kentucky, was found guilty […]

This year, key information regarding the Appropriate Use Criteria (AUC) program is being released by the Centers for Medicare & Medicaid Services (CMS) via guidance documents. A Change Request was issued July 26, 2019, informing Medicare Administrative Contractors (MACs) that they are to begin accepting AUC-related modifiers and healthcare common procedure coding system (HCPCS) codes […]

IMPORTANT NEWS FOR HOME HEALTH AGENCIES – In a fact sheet released July 11, 2019, the Centers for Medicare & Medicaid Services (CMS) detailed its annual update to the Medicare rate, as well as its plan for the implementation of the Patient-Driven Groupings Model (PDGM) and other proposals for calendar year (CY) 2020, which can […]