Effective January 1, 2018, federal law requires that all Medicaid Managed Care Network providers, as well as all Children’s Health Insurance Program providers, enroll with state Medicaid programs. For example, this applies to a provider that currently participates in a network with a New York State Medicaid managed care plan that provides services to, or orders, prescribes, or certifies eligibility for services for Medicaid-eligible individuals. The mandated enrollment must include “providing identifying information including name, specialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number, and the state license or certification number.”
As of April 23, 2017, Medical Answering Services, LLC (MAS) will serve as the Medicaid transportation manager for the New York City region. This region includes New York, Kings, Richmond, Queens, and Bronx counties. MAS currently serves 2,000,000 Medicaid enrollees in 55 counties in the Hudson Valley, Finger Lakes, Northern New York, and Western New […]
The United States Department of Justice (“DOJ”) reported that it obtained over $4.7 billion in civil settlements and judgments involving federal False Claims Act fraud and abuse claims against the government in 2016. This is the third highest yearly total since the False Claims Act was enacted during the Civil War to help deter fraud […]
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the Health Care Compliance Association (HCCA) released Measuring Compliance Program Effectiveness: A Resource Guide on March 27, 2017 (“the Guide”). The Guide was created by the HCCA-OIG Compliance Effectiveness Roundtable which convened in Washington, D.C., in January 2017 to explore ways […]
On April 17, 2017, the United States Government Accountability Office (GAO) released a report about the current state of Medicaid program integrity. GAO conducted a study of the Medicaid program due to concerns about improper payments and was asked to conduct a study of the Centers for Medicare & Medicaid Services (CMS) to determine the […]
The New York State Office of the Medicaid Inspector General (“OMIG”) has released its annual Work Plan for fiscal year 2017-18. The annual Work Plan offers providers insight into OMIG’s areas of focus in the New York State Medicaid program for the upcoming year. As stated in the Work Plan, the OMIG’s overall mission “is […]
This month’s column in the Albany County Bar Association Newsletter reflects on the changes and potential changes to the health care sector under President Trump’s first 30 days.
The Centers for Medicare and Medicaid Services (CMS) announced that Performant Recovery, Inc., New York’s Medicare Fee-for-Service Recovery Audit Contractor (RAC) for Region 1, can begin recovery audit activity now that provider outreach is complete. Region 1 includes the following groups of states: J8, WPS: Michigan and Indiana; J15, CGS: Ohio and Kentucky; JK, NGS: New […]
This month’s column in the Albany County Bar Association Newsletter addresses the rise of individuals playing Pokémon GO in healthcare facilities and the issues that healthcare facilities should consider to address the rising trend.
Recently, the Counsel of OASAS, Robert Kent, sent a memorandum to all providers regarding Justice Center incident reporting policies and procedures for all OASAS providers. OASAS has also published a guidance document for incident reporting to the Justice Center under Part 836 of the OASAS regulations. Many OASAS providers have a process and procedure whereby […]