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CMS Proposes Payment Changes for Medicare HHAs for 2019

The Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposed rule that will impact payment and policy for home health agencies and home infusion therapy suppliers. The proposed rule is an update to the Medicare home health prospective payment system rates for calendar year 2019, as well as a broader case-mix […]

Medicare Device Maker Settles False Claims Allegations, Agrees to Pay $12.5M

A New York-based medical device manufacturer has agreed to pay $12.5 million to settle allegations it caused healthcare providers to submit false claims to federal healthcare programs relating to the use of two of its medical devices. AngioDynamics Inc. was accused of causing false claims to be submitted to Medicare, Medicaid, TRICARE, and other federal […]

CMS Proposes Sweeping Changes to Restore Doctor-Patient Relationship

Talk to any healthcare provider and one of the things you likely will hear is that they spend too much time on paperwork and not enough time with patients. The Centers for Medicare & Medicaid Services (CMS) says it wants to change that. Earlier this month, the agency that administers the Medicare program proposed what […]

Sen. Rubio to Introduce Bill to Crackdown on Florida Shuffle

Have you heard of the Florida Shuffle? It’s not a new dance step, it’s what they call it when substance abusers come to Florida to get clean, leave treatment, continue using and come back again, all the while having their treatment paid for by insurance. Florida is, according to published reports, the nation’s second most […]

Common Healthcare Fraud Schemes

Last month’s indictment of more than 600 people nationwide in what the feds dubbed “the largest healthcare fraud takedown in history,” should serve as a warning that the government is serious about cracking down on those who abuse the system. As we wrote about in June, of the 601 defendants charged, 165 were medical professionals […]

HIPAA Violation Results in $4.3M Fine for Cancer Center

If you haven’t taken stringent measures to protect patient privacy, this recent ruling from a U.S. Department of Health and Human Services Administrative Law Judge might spur you into action. The ALJ ruled that University of Texas MD Anderson Cancer Center violated HIPAA Privacy and Security Rules and granted summary judgment to the Office for […]

Doctors, Nurses, Other Healthcare Pros Rounded up in Opioid and Medicare Fraud Sweep

Doctors, nurses, addiction treatment professionals, pharmacists and hundreds of others are among the 601 people across 58 federal districts charged this week in what the Justice Department is calling “the largest national healthcare fraud enforcement action” in its history. The fraud resulted in more than $2 billion in losses. Of those 601, more than 162 […]

Do you Know Your Obligations Under the Medicare Secondary Payer (MSP) Provisions?

A Philadelphia-based personal injury law firm has paid $28,000 to settle allegations that it failed to reimburse the government for Medicare payments made to healthcare providers on behalf of its clients. The agreement should serve as a reminder to personal injury lawyers and others of their obligation to reimburse Medicare for conditional payments after receiving […]

Advisory Opinion: Clinic Can Provide Free Telemedicine Equipment, Services

A nonprofit, federally qualified health center look-alike (FQHC) can use grant funds to provide telehealth equipment and services for free to facilitate encounters with patients of a county-run clinic that provides testing, treatment and counseling for HIV, based on a recent advisory opinion issued by the Department of Health and Human Services Office of the […]

CMS Policy Changes to Drug Benefit Program Targets Opioid Abuse

Effective June 15, policy changes for the prescription drug benefit program finalized by the Centers for Medicare & Medicaid (CMS) take effect. CMS published the final rule updating Medicare Advantage (MA) and the prescription drug benefit program (Part D).  The new rule is expected to result in nearly $300 million in annual savings over five […]

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It is not intended as professional advice and should not be construed as such.