Auditing the Auditors: OSC vs. OMIG

The Office of the New York State Comptroller (OSC) has just announced that it will be conducting an audit of the New York State Office of the Medicaid Inspector General (OMIG).   The audit, which is scheduled to be commenced June, is said to have been sparked by a congressional report (entitled “Billions of Federal Tax Dollars Wasted Annually […]

HIPAA Final Rule Posted

This afternoon, the Department of Health and Human Services posted a long-awaited, 563-page omnibus final rule under HIPAA, which will be published in the Federal Register on January 25, 2013, and which makes a variety of modifications to HIPAA’s Privacy, Security, Breach Notification, and Enforcement Rules.  According to the executive summary of the rule, these modifications are […]

OMIG Adopts Regulations Concerning Withholding of Medicaid Payments When Fraud Is Alleged

In accordance with federal law, the OMIG has finalized proposed regulatory changes to conform New York State law to federal law regarding the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” This requirement is imposed on States that participate in the Medicaid program as part of the the Affordable […]

HHS OIG Identifies $332 Million in Uncollected Medicare Overpayments

On Friday the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) made public a report which revealed that the Centers for Medicare and Medicaid Services (“CMS”) had failed to collect over $332 million in Medicare overpayments, for the 30-month period ending March 31, 2009. During that time, OIG had issued […]

CMS Releases Proposed Rules for Reporting and Returning Medicare Overpayments for Parts A and B

The Centers for Medicare & Medicaid Services (CMS) released proposed rules (42 C.F.R. Part 401, Subpart D) for Medicare overpayments to implement section 6402(a) of the Affordable Care Act enacted in 2010.  The Act requires that overpayments be reported and returned to the appropriate Medicare or Medicaid contractor within (60) days from the date the […]

D.C. Circuit Upholds Individual Mandate Provision in PPACA

Today, in a 2-1 split decision, the United States Court of Appeals for the District of Columbia upheld the constitutionality of the individual health care mandate in the Patient Protection in Affordable Care Act. Writing for the majority, Judge Laurence H. Silberman rejected the opponents’ argument that the law exceeded the powers of Congress under the Commerce […]

CMS Publishes Regulations on Accountable Care Organizations

Today, CMS published its final rule implementing the part of the Affordable Care Act governing Accountable Care Organizations (ACOs). A copy of the rule is available here. The portion of the Affordable Care Act implemented under this new rule requires the establishment of the Medicare Shared Savings Program. The Shared Savings Program, in turn, encourages […]

President’s Deficit Reduction Plan Proposes $42 Billion Cut to SNFs, Post-Acute Care Providers

President Obama’s recently released deficit reduction plan proposes to cut more than $320 billion dollars in Medicare and Medicaid spending over the next decade.  Within the planned cuts are proposals designed to curb $42 billion dollars of Medicare reimbursement to SNFs and other post-acute facilities.  According to the President, expenditures for services these facilities provide […]

Federal Appellate Courts Now Split over PPACA’s Individual Mandate

Late Friday afternoon the Eleventh Circuit Court of Appeals ruled that PPACA’s “individual mandate” – requiring virtually every American to purchase health insurance by 2014 – is unconstitutional.  In a 2-1 opinion exceeding 300-pages in length, the majority reasoned that upholding the controversial mandate would grant Congress powers beyond those intended by the Constitution. The […]

Phase One Applications for NYS Medicaid Health Homes Being Accepted by NYSDOH

The New York State Department of Health (DOH) is now accepting applications from providers to participate in the Health Homes for Individuals with Chronic Medical and Behavioral Health Conditions program, better known as New York’s Medicaid Health Homes program.  The program is a new initiative by the State’s Medicaid Redesign Team (MRT) to provide more […]