Michigan Medicaid enrollment is increasing, due to the challenging economic status of the state, says the Detroit News. However, also due to the state’s economy, Medicaid is cutting reimbursement payments to physicians, causing many of them to turn down new or even all Medicaid patients. According to physicians, the reimbursements they receive from Medicaid, even […]
On August 3-4, 2009, Abby Pendleton, Esq. will speak at the World Research Group’s Healthcare Management Conference titled “Preparing for the Next Round of Medicare RAC Reviews.” Ms. Pendleton, a founding member of The Health Law Partners, P.C., will present among several experts in the field of Recovery Audit Contractors. She will discuss how to […]
Liability under the Civil False Claims Act has been expanded. On May 20, 2009, President Obama signed the Fraud Enforcement and Recovery Act (FERA) into law. FERA contains amendments to the civil False Claims Act (FCA) that expand liability under FCA and gives the government increased powers to investigate. According to FERA, an entity violates […]
Out of network patient billing gives rise to many issues. As a result, some health care providers, including physician groups and ambulatory surgery centers, have struggled with the decision to participate or not to participate in various insurance plans. In addition to the political considerations that arise, various state and federal laws also may apply […]
The CFO and treasurer of PRG-Schultz International, Peter Limeri, will resign on May 31. PRG-Schultz is a subcontractor in the Centers for Medicare and Medicaid Services (CMS)’ Recovery Audit Contractor (RAC) program that identifies and corrects past improper payments from healthcare providers. As a subcontractor, PRG-Schultz keeps between 9% and 12.5% of the payments they […]
The Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)’s formation was announced today by US Attorney General Eric Holder and U.S. Secretary of Health and Human Services (“HHS”) Kathleen Sebelius. The purpose of HEAT is to assist in the crackdown on Medicare fraud. HEAT will be comprised of members of both the Department of […]
Ambulatory Surgery Centers (“ASCs”) need to take note of additional federal Conditions for Coverage (“CFCs”) governing patient rights that took effect May 18, 2009. The Amendments to these CFCs, which the Centers for Medicare and Medicaid Services (CMS) published on November 18, 2008, are codified at “Part 416 – Ambulatory Surgical Services” (42 CFR 416.50). […]
A presentation explaining basic information about Recovery Audit Contractors (RACs) was published by The Centers for Medicare and Medicaid Services (CMS) on their website. The presentation describes RACs as a way to identify and resolve past improper payments, as well as provide reason to avoid future improper payments. Any entity that bills fee-for-service programs is […]
The Centers for Medicare and Medicaid Services (CMS) posted a new FAQ regarding Recovery Audit Contractors (RACs) on their website. The FAQ inquires what claim dates CMS uses to determine RAC medical record request limits for a fiscal year. CMS responded that they originally intended to use a designated calendar year’s claims to create limits […]
Medicare trust funds are expected to deplete sooner than projected last year, according to a report released by Medicare trustees. While their 2008 report estimated that funds would run out in 2019, this year’s report predicts that funds will exhaust in 2017. The current economic recession, an increasing need to address the public health crisis, […]
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