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Showing 6 posts in Medicare.

Federal Legislation Addresses National Opioid Crisis, Will Impact the Entire Healthcare Industry

The U.S. healthcare industry needs to be aware of recent federal legislation that was signed into law on October 24, 2018. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment, or SUPPORT for Patients and Communities Act, H.R.6, was signed into law as a response to the national opioid crisis. The law broadly addresses the opioid crisis in ways that will affect the entire health care industry. The law is immediately effective, except for certain individual provisions which specifically define when they will go into effect. More ›

CMS Requires Hospitals to Publish Standard Charges on the Internet

Section 2718(e) of the Public Health Service Act, which was enacted as part of the Affordable Care Act, updated Medicare payment policies to require that "each hospital operating within the United States, for each year, establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital's standard charges for items and services provided by the hospital." CMS provided guidance for implementation and stated hospitals are required to make the list of their standard charges, or their policies for public access to the list, available upon inquiry. More ›

Sixth Circuit Applies Escobar Ruling in Decision to Resuscitate False Claims Act Case

The United States Court of Appeals for the Sixth Circuit recently resuscitated a qui tam action under the False Claims Act (FCA), and, in so doing, held that the relator had properly alleged materiality under the U.S. Supreme Court's decision in Universal Health Services Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989, 2002 (2016). The Sixth Circuit's decision, U.S. ex rel. Prather v. Brookdale Senior Living Communities, Inc., 892 F.3d 22 (6th Cir. June 11, 2018) addressed a relator's claims under the FCA. The FCA imposes civil liability on those who defraud the federal government by levying fines and penalties, including up to three times the government's damages. Private persons called relators file lawsuits or qui tam actions for violations of the FCA on behalf of the government. More ›

More than 600 Healthcare Professionals Hit by DOJ with Medicare Fraud Charges

The number of criminal charges filed annually by the Department of Justice (DOJ) against health care providers and professionals continues to escalate. On June 28, 2018, the DOJ announced that the Medicare Fraud Strike Force had charged 601 individuals across the United States, including more than 150 physicians, nurses, and other licensed medical professionals for participating in health care fraud schemes involving more than $2 billion in false billings this summer. At the same time, the U.S. Department of Health and Human Services initiated suspension actions against numerous providers, including doctors, nurses, and pharmacists. More ›

OIG Targets Chiropractors Yet Again in Report Recommending Aggressive Audit Procedures

Unsatisfied with prior efforts to curtail Medicare billing of chiropractic services, the Office of Inspector General (OIG) is doubling down by targeting chiropractors yet again. In 2013, the OIG estimated that $358.8 million or approximately 82% of all money paid by Medicare for chiropractic services was unallowable and issued instructions to CMS to use more scrutiny in paying for chiropractics services.   More ›

Healthcare Providers Beware: Medicare Billing Can Be Risky Business

When a health care provider or third party billing service submits a claim for services rendered to a Medicare patient, it’s filing a bill with the government that certifies the payment was earned and complies with certain billing requirements. More ›

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