Medicaid Fraud: Grand Larceny or Is Another Doctor Just Getting Played?

The recent June 3, 2011 indictment of Suresh Hemrajani, a Washington Heights doctor, by the Manhattan District Attorney’s Office, at first glance appears to be simply another Medicaid doctor accused of stealing $700,000 from Medicaid by billing and writing expensive human immunodeficiency virus (HIV) prescriptions for “patients” who did not actually have AIDS.  A closer […]

Progress Report Outlines Accomplishments of Medicaid Redesign Team

Governor Cuomo recently released a progress report outlining his Medicaid Redesign Team’s accomplishments to date.  Governor Cuomo created the Medicaid Redesign Team in January 2011 “to reduce costs and increase quality and efficiency” in New York’s Medicaid program.  New York spends more than $53 billion each year on Medicaid.

Gov. Cuomo Submits Health Benefit Exchange Bill to Rival NY Senate Majority Bill

New York State Governor Andrew Cuomo submitted a Governor’s program bill yesterday, June 13, 2011, proposing legislation that would comply with the requirements of the Federal Patient Protection and Affordable Care Act (PPACA) to create a Health Benefit Exchange.  The exchange, once established, will be a statewide “marketplace” through which individuals and small business who do not have […]

Vermont Establishes Single Payer System

On May 26, 2011, Vermont Governor, Peter Shumlin, signed a bill that will establish a statewide publicly funded single-payer health care system.  The bill will create a “universal and unified health system” called “Green Mountain Care” and all of the state’s residents will be eligible for coverage. The Governor issued a written statement announcing the […]

HHS Releases HIPAA Privacy Rule Accounting of Disclosures

The Department of Health and Human Services (HHS) issued its notice of proposed rulemaking to modify the HIPAA Privacy Rule’s standard for accounting of disclosures of protected health information (PHI). The current accounting provision applies to disclosures of paper and electronic PHI, regardless of whether such information is in a designated record set (DRS), for […]

First Meeting of the Public Health and Health Planning Council

The Public Health and Health Planning Council, whose first meeting scheduled for June 2 never took place, has rescheduled its first business meeting for tomorrow, Thursday, June 9, 2011.  At this meeting, the PHHPC is expected to adopt bylaws, elect the Vice Chair, populate its Committees, adopt a 2011 calendar, and adopt guidelines for the […]

CMS Proposes Rule to Make Medicare Data Available for Public Reports About Providers

The Patient Protection and Affordable Care Act (“PPACA”) requires that “standardized extracts” of Medicare claims data be made available to “qualified entities” in connection with their preparation of reports evaluating the performance of providers.  Since this information is now “required by law,” these disclosures are allowed under the Health Insurance Portability and Accountability Act’s Privacy […]

HHS OIG Finds Potential Anti-Kickback Violations in Online Referral Service

In an advisory opinion dated May 13, 2011, the Department of Health and Human Services, Office of the Inspector General (“OIG”) warned the operator of an online referral system that charging health care providers a fee to list their services on the system could potentially violate the Anti-Kickback Statute and lead to administrative sanctions, including […]

Arkansas Federal Court Determines that Arbitration Agreement Is Not Prohibited “Other Consideration” under Medicaid Regulations

Medicaid law forbids nursing facilities from requiring “any gift, money, donation, or other consideration” as a precondition of admission to that facility.  See 42 U.S.C. § 1396r(c)(5)(A)(iii); 42 C.F.R. § 483.12(d)(3).  On May 10, 2011, the United States District Court for the Western District of Arkansas ruled that an arbitration agreement as a precondition of […]

Governor Cuomo Announces, and Senate Confirms, the New Public Health and Health Planning Council

Governor Andrew Cuomo announced nominations for the newly established Public Health and Health Planning Council (“PHHPC”) early last week.  The members of the former Public Health Council will be joined by twelve new appointees confirmed by the Senate on Tuesday to create the new Council, consisting of a twenty-four member committee plus the Commissioner of […]