Tag Archives: Providers

Applicability of Fraud and Abuse Rules to the Marketplace Clarified … Somewhat

One of the lingering questions about the Health Insurance Marketplace created under the Affordable Care Act is whether plans on the Marketplace are considered part of a Federal health care program, thus opening up potential liability under the Anti-Kickback Statute. … Continue reading

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Jason Helgerson Makes MLTC Encounter Data a Priority

At a Managed Care Policy Meeting held last week with managed care plans, New York’s Medicaid Director, Jason Helgerson, spoke about the importance for plans to submit timely and accurate encounter data.  He noted that managed long term care plan … Continue reading

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Health Planning Committee of the Public Health and Health Planning Council Proposes Significant Certificate of Need Redesign

The Health Planning Committee of the Public Health and Health Planning Council is proposing a significant Certificate of Need (“CON”) redesign. The Committee and Council are expected to make twenty-two (22) recommendations to the Department of Health next week, affecting … Continue reading

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CMS Issues Section 1135 Waivers for New York and New Jersey

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.  … Continue reading

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The danger of unencrypted protected health information: 55,000 patients’ PHI exposed.

An Indianapolis oncology group has disclosed that data concerning about 55,000 patients was stored on a stolen laptop computer.  A backup copy of the Cancer Care Group’s server was stored on the computer, which was stolen from a locked car.  … Continue reading

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OMIG Releases Compliance Alert for Medicaid Providers

The New York State Office of Medicaid Inspector General (“OMIG”) recently released a Compliance Alert that explains what types of Medicaid providers are required to have a compliance program and what steps those providers can take to ensure that they … Continue reading

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HIPAA: Conversion to Version 5010

As of January 1, 2012, all healthcare providers were required to transition from version 4010/4010A to version 5010 standards for submitting electronic transactions, and the failure to comply may result in claim denials or a government investigation. CMS has repeatedly … Continue reading

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United States HHS OIG Reviewing Self Disclosure Protocol for Federal Health Care Programs

The federal government’s Office of the Inspector General (“OIG”), part of the United States Department of Health and Human Services, is considering revising its self-disclosure protocol to provide additional guidance to federal health care program providers.  The OIG is soliciting … Continue reading

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Gov. Cuomo Announces Agreement on Justice Center Legislation to Protect People with Special Needs and Disabilities

Today, Governor Andrew M. Cuomo, Senate Majority Leader Dean Skelos, and Assembly Speaker Sheldon Silver announced an agreement on legislation that will establish a new Justice Center for the Protection of People with Special Needs, which will change how the … Continue reading

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New York Attorney General Settles Balance Billing and Overpayment Disputes

New York State Attorney General Eric Schneiderman announced on Tuesday that it had reached settlements with Group Health Inc. (“GHI”) and a New York City health care provider regarding overpayments to consumers. GHI has agreed to repay consumers for approximately … Continue reading

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