The Centers for Medicare and Medicaid Services (“CMS”) has issued additional blanket waivers retroactive to March 1, 2020 through the end of the emergency declaration to help healthcare providers contain the spread of COVID-19. The updated waivers were released on April 29, 2020 and are an update from those issued on April 21, 2020. The
New CMS Waivers for Stark Law, NCD, LCD and Supervision Requirements During Public Health Emergency
Physicians enrolled in Medicare are all-to-familiar with the constraints of the Stark Law which prohibits physicians from making referrals for designated health services (“DHS”) payable by Medicare when the physician (or immediate family member) has a financial relationship with the entity performing the DHS. On March 30, 2020, CMS announced a number of Stark Law
Who You Affiliate with Could Jeopardize Your Medicare Enrollment
On September 10, 2019, the Centers for Medicare and Medicaid Services (“CMS”) published a Final Rule in the Federal Register which will require Medicare, Medicaid, and Children’s Health Insurance Program (“CHIP”) providers and suppliers to disclose current and previous affiliations with other providers and suppliers who CMS identifies as posing an undue risk of fraud,
Louisiana Department of Health Issues Emergency Rules Impacting Pediatric Day Health Care Facilities
The Louisiana Department of Health issued two Emergency Rules in the September 20, 2016 Louisiana Register amending licensing standards governing Pediatric Day Health Care Facilities in an effort to avoid a budget deficit in the medical assistance program. The Emergency Rules revised the PDHC’s Program description and criteria to provide that in order to receive
EDLA Confirms That LHWCA Medical Benefits Are Not Subject To Collateral Source Rule
The application of the collateral source rule is a common dispute in personal injury litigation because it affects the amount of recoverable damages in the case. When it applies, the defendant is potentially on the hook for a higher amount of past medical expenses, typically, the amount invoiced by the medical providers. When it does
CMS Issues Final Rule for Face-to-Face Requirements for Home Health Services Covered by Medicaid
The Department of Health and Human Services, Centers for Medicare and Medicaid (“CMS”) issued a final rule on February 2, 2016 regarding the requirements for a face-to-face encounter for patients receiving home health services payable by Medicaid. In order to ensure that states and providers appropriately implement the provisions in the final rule, CMS revised
United States Supreme Court to Address the Theory of “Implied Certification” Under the False Claims Act
On December 4, 2015, the United States Supreme Court granted a Petition for a Writ of Certiorari in Universal Health Services, Inc. v. United States and Commonwealth of Massachusetts ex rel. Julio Escobar and Carmen Correa. The Petition was filed by Universal Health Services, Inc. (“UHS”) challenging the United States Court of Appeals for the
OIG Would Not Sanction Arrangement Involving Payment to Excluded Provider for Pre-Exclusion Services
The latest OIG Advisory Opinion, issued February 9, 2015, addresses the issue of sharing federal health care program payments with an excluded practitioner. While federal statutes prohibit payment by any federal health care program, including Medicare or Medicaid, for items or services furnished by an excluded person or furnished at the medical direction or on
DHH Implements Recovery Audit Contractor Program
The Louisiana Department of Health and Hospitals (“DHH”) adopted provisions to establish the Recovery Audit Contractor (“RAC”) Program, effective November 20, 2014, as required by the Affordable Care Act. The new RAC program provides yet another mechanism by which DHH, through its contractors, can conduct post-payment audits of claims submitted by providers enrolled in Medicaid.