Attention Medicaid Managed Care/CHIP Program Providers: You Must Enroll in the Medicaid Program Effective 01/01/2018

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 […]

Medical Answering Services, LLC Awarded Contract for Medicaid Transportation Services Management in the New York City Region

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 […]

Medicaid Program Integrity: US GAO Finds CMS Needs Work to Develop More Effective Oversight Efforts

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 OMIG Releases its 2017-2018 Work Plan

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 […]

Governor Cuomo Announces Over $50 Million in Funding for Home Health Services for Senior Citizens Not Yet Eligible for Medicaid

Today, New York Governor Andrew Cuomo announced that $50 million in funding from the state’s Expanded In-Home Services for the Elderly Program has been awarded to the state’s county-based Area Agencies on Aging for the purpose of helping New York’s senior citizens to obtain home health care services.  The press release states that the funding “will […]

SCOTUS Decides Implied Certification Issue in Key False Claims Act (Whistleblower) Case

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 […]

O&A Offers Healthcare Payment Cycle and Financial Consulting for Challenging Markets

In the post-recession world of tighter credit, the close management of payment cycles, accounts receivable, payables, debt and financing obligations, and cash flow has become even more critical to maintaining healthy businesses. Management of these issues also impacts the successful start-up of new practices, facilities or acquisitions.  While these issues apply equally to healthcare market, […]

Comptroller Claims NYSDOH Leaves $95 Million of Drug Rebates on the Table

This week, the New York State Comptroller, Thomas P. DiNapoli, issued audit findings which claimed that the New York State Department of Health (“DOH”) failed to capture $95,100,000 in prescription drug rebates it was eligible to receive on drugs administered through the New York State fee-for-service program and the Medicaid Managed Care program from April […]

CMS Solicits Comments on New Antikickback Safe Harbors

The Centers for Medicare and Medicaid Services (“CMS”) is soliciting topics for new safe harbors and special fraud alerts.  The solicitation appeared in the December 23, 2015 Federal Register, and is made each year. Interested commenters have 60 days to submit their proposals.  The solicitation may be viewed here.

Behavioral Home and Community-Based Services Delayed

The New York State has delayed implementation of Behavioral Home and Community-Based Services (“HCBS”) outside of New York City.  These new services were scheduled to begin on July 1, 2016, but are now slated to be phased in three months later, on October 1, 2016. Non-HCBS behavioral health care services will be offered through Medicaid […]