Last week, we highlighted that the Centers for Medicare and Medicaid Services (“CMS”) released a long-awaited final rule regarding its interpretation of the statutory obligation of Medicare Part A and Part B providers to return any overpayments they receive from the program within 60 days after such an overpayment is “identified.” The final rule is […]
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.
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 […]
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.
On Wednesday, October 2, the Centers for Medicare and Medicaid Services (“CMS”) issued its 2015 consultation guide for states to use when setting reimbursement rates with respect to any Medicaid managed care program subject to actuarial soundness requirements in 42 CFR 438.6 during rating periods starting January 1, 2015. The guide “describes information that CMS expects states to provide […]
Through their Health Care Fraud Abuse Control program (“HCFAC”), the United States Departments of Justice (“DOJ”) and the United States Department of Health and Human Services (“HHS”) have recovered more than $19 billion from health care providers over the last five years. A report released on February 26 shows that the program’s three-year return on […]
Today, CMS issued a Press Release announcing that it is conducting a demonstration project with New York State known as the Fully Integrated Duals Advantage (FIDA) demonstration. Under this capitated demonstration, approximately 170,000 New Yorkers who are people eligible for Medicaid and Medicare in NYC, Long Island and Westchester County will be able to join […]
On June 20, 2013, at the Managed Care Policy Meeting, Jason Helgerson announced that the House Oversight Committee has asked CMS to investigate managed long term care plans related to the use and possible abuse of social day care programs in New York City. Mr. Helgerson reminded Plans that enrollment from Social Day Care Programs […]
The Centers for Medicare and Medicaid Services (CMS) approved waivers for New York and New Jersey under Section 1135 of the Social Security Act. The waivers ease certain legal requirements on healthcare providers who are serving those impacted by Sandy. The Section 1135 waiver for New York is available here. The waivers relax the rules […]
In U.S. ex rel. Williams v. Renal Care Group, Inc. (Case No. 11-5779) (October 5, 2012), the Sixth Circuit Court of Appeals reversed a grant of summary judgment in favor of the United States on two main False Claims Act (FCA) claims relating to Medicare reimbursement of dialysis supplies. In doing so, the Court issued […]