Office of the State Comptroller Issues Medicaid Program Integrity Report

The New York State Medicaid program is projected to have a $62 billion-dollar price tag in State Fiscal Year 2016, with $22.4 billion paid out by the State, as explained by the New York State Office of the Comptroller (“OSC”) in its April 2015 report entitled Ensuring Integrity in New York State Medicaid.   As Medicaid […]

Medicare Reimbursement Standards Take Center Stage in Dismissal of False Claims Act Case

Our monthly Health Law Update from the Albany County Bar Association Newsletter has been released a few days early.  This month’s article discusses a Georgia federal court decision granting summary judgment to a nursing home and a rehabilitation therapy provider in a Federal False Claims Act prosecution that alleged the unnecessary provision of rehabilitation therapy services. Although the […]

Regulatory Focus on Mental Health Parity Laws

This month’s article from the Albany County Bar Association Newsletter discusses the New York Attorney General’s recent settlement with Excellus, a Rochester-based health insurer, which resulted from an investigation into complaints from consumers that Excellus was improperly denying claims for mental health and substance abuse treatment.  The article also includes a brief overview of New […]

Seventh Circuit Decision Highlights Scope of Anti-Kickback Statute

This month’s article from the Albany County Bar Association Newsletter offers brief summary of the recent decision in U.S. v. Patel, in which a physician was found to have violated the federal Anti-Kickback statute for an improper referral scheme with a home health agency, even though he did not actively divert patients to other providers. The […]

The Trouble with RACs

It seems the United States House of Representatives has taken aim at Medicare Recovery Audit Contractors (“RACs”). The RACs are private, non-governmental entities that are authorized by the Medicare program to conduct audits of Medicare providers and suppliers. In December, 2013, the Office of Medicaid Hearings and Appeals (“OMHA”) sent a letter to providers with […]

Attention Medicaid and Medicare Providers: US DOJ Sues Providers for Failing to Return Overpayments Within 60 Days

On June 27, 2014, in the case of United States ex rel. Kane v. Healthfirst, Inc., et al., No. 11-2325 (S.D.N.Y.), the United States Department of Justice (USDOJ), via the United States Attorney’s Office for the Southern District of New York, sued several Medicaid providers under the federal False Claims Act for failing to return […]

HHS OIG 2010 Medicare Audit: $6.7 Billion Misspent for Evaluation and Management Services

The United States Department of Health and Human Services Office of the Inspector General (“OIG”) has completed its audit of 2010 Medicare payments for Evaluation and Management (“E/M”) services. The audit report, available at  https://oig.hhs.gov/oei/reports/oei-04-10-00181.asp, states that the Medicare program overpaid providers $6.7 billion for E/M services that were incorrectly coded or lacked documentation in […]

OMIG Posts Assisted Living Program Audit Protocols

The New York State Office of the Medicaid Inspector General (OMIG) has released its final audit protocols for Assisted Living Programs (ALPs). These protocols became effective November 22, 2013 and are the OMIG’s audit tool that they will use when conducting their audits of ALPs.  The protocols contain 22 areas of potential disallowances based upon […]

Medicare Payments for Zombies: OIG reveals that Medicare Advantage payments sometimes outlive beneficiaries

Just in time for Halloween, in a Medicare audit, the Office of the Inspector General of the Department of Health and Human Services has found that $23 million in Medicare expenditures in 2011 were paid inappropriately after the beneficiary had died.  The vast majority of these overpayments, 86 percent, flowed from Medicare Part C, also […]