In a decision that is poised to have resonating implications for health services providers, the Supreme Court of the United States explicitly endorsed the “implied false certification theory of liability” under the False Claims Act (FCA) in Universal Health Services, Inc. v. U.S. ex rel. Escobar. Under this theory of liability, any person who submits […]
This morning, the Centers for Medicare and Medicaid Services (“CMS”) made available a copy of a final rule clarifying the obligations of providers and suppliers to report and return Medicare overpayments within 60 days after the date on which the overpayment was identified. The final rule will be published in tomorrow’s Federal Register.
Alcoholism, substance abuse and chemical dependency treatment providers should be aware that the Substance Abuse and Mental Health Services Administration (“SAMHSA”) has promulgated proposed changes to regulations regarding the privacy and confidentiality of what are now called “substance use disorder” treatment records. Those privacy regulations, which are located at 42 C.F.R. Part 2, are well […]
Today, the Department of Justice U.S. Attorney’s Office for the Northern District of New York announced a settlement with Medical Reimbursement Systems, Inc. (“MRSI”) to resolve allegations that it violated the false claims act. The press release can be found here. Medical Reimbursement Systems, Inc. provided billing, coding and full revenue cycle services for health care […]
On August 3, 2015, Judge D.J. Ramos of the Southern District of New York denied Healthfirst’s motion to dismiss the United States’ action under the False Claims Act (FCA) and the related state action. Healthfirst contended in its motion that the government failed to sufficiently plead the case. Notably, in denying this motion, the court […]
The New York State Office of the Medicaid Inspector General (“OMIG”) has released its State Fiscal Year 2015-2016 Work Plan. The Work Plan is a road map of where the OMIG intends to go in terms of its anti fraud, waste and abuse efforts with respect to the Medicaid program. The OMIG’s stated mission is […]
The New York State Office of the Medicaid Inspector General (“OMIG”) has released Compliance Guidance for use by DSRIP (Delivery System Reform Incentive Payment) Performing Provider System (“PPS”) Leads who are in the process of developing and implementing a compliance program. The document highlights special considerations PPS Leads should contemplate for each of the eight […]
This month, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) released its audit report for Ulster County’s 24-hour personal care services program.
In 2011, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) investigated New York City’s Medicaid claims for continuous 24-hour personal care services, an area that previous HHS OIG audits consistently identified as one vulnerable to fraud, waste, and abuse.
Medicaid Fraud Control Units (“MFCUs”) have a responsibility to combat Medicaid fraud and patient abuse and neglect. Toward that end, each MFCU maintains statistical data as to the number of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases. Each year, a summary […]