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On July 26, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced an unprecedented partnership between private and public healthcare insurance organizations focused on fighting healthcare fraud. Continue reading » Similar to the Stark Law, the Antikickback statute seeks to regulate the financial relationships between physicians and/or other provider entities where there is a possibility of patient referrals for items or services reimbursable by a Federal health care program. Continue reading » The New York State Medicaid Program recognizes that certain Medicaid enrollees are not able to use mass transit or other forms of transportation to get to and from a doctor’s appointment and “[i]f the enrollee cannot get to medical services, then the Program fails from the start.” To that end, Medicaid covers the least costly, most medically appropriate level of transportation to and from services covered by the Medicaid Program. Continue reading » The New York State Medicaid transportation program has undergone some changes recently. In January, the New York State Department of Health (DOH or Department) announced that a contract was awarded to LogistiCare Solutions to manage the transportation needs of Medicaid enrollees. Each New York City borough will be brought under the management of the contractor in phases. Continue reading » The federal self-referral law, often referred to as the Stark Law, prohibits a physician from referring patients to receive “designated health services” (DHS) payable by Medicare or Medicaid to an entity with which the physician or an immediate family member has a financial relationship. See 42 U.S.C. §1395nn. Continue reading » The New York State’s Office of the Medicaid Inspector General (OMIG) recently released the agency’s 2012-2013 workplan. The agency’s focus remains firmly on fighting fraud, waste and abuse, compliance and self-disclosure, and provider education. We look closer at how the OMIG plan impacts pharmacy and durable medical equipment (DME) businesses. Continue reading » In the workplan released earlier in the week, the New York State Office of the Medicaid Inspector General (OMIG), which is an independent agency within the Department of Health, renewed its commitment to fighting fraud, waste and abuse in the New York Medicaid Program. One of the nine business lines that the agency will focus on during the 2012-2013 fiscal year includes the following three providers: physicians, dentists and laboratories. Continue reading » The New York Medicaid Program pays costs of all emergency ambulance and medically necessary non-emergency transportation, as well as the necessary transportation expenses for Medicaid enrollees who must travel an extraordinary distance to receive medical care. The New York Medicaid Program will only reimburse transportation providers if specific records verifying an occurrence of a trip are maintained for each leg of the trip. Continue reading » The New York State Medicaid Program announced in its official publication that the NY Medicaid program will no longer cover certain treatments for chronic low back pain. The change is effective immediately for Medicaid fee-for-service beneficiaries and effective June 1, 2012, for Medicaid managed care and Family Health Plus (FHPlus) enrollees. NY Medicaid will no longer reimburse the following procedures:
Medicaid now considers these procedures ineffective, or experimental and investigational. Medicaid, however, will continue to cover:
If you have questions about the New York Medicaid reimbursement policies or need legal assistance, please contact us. The New Jersey Medicaid and New Jersey FamilyCare programs insures more than one million New Jersey residents. To verify that the state’s Medicaid dollars are spent effectively, and to comply with federal law that requires that state Medicaid programs investigate fraud, waste and abuse, the New Jersey legislature passed the Medicaid Program Integrity and Protection Act (N.J.S.A. 30:4D-53 et al), which established the office of the Medicaid Inspector General (OMIG), now the Medicaid Fraud Division (MFD or Division) within the office of the State Comptroller. Continue reading » Yesterday the Department of Health and Human Services announced a proposed rule that would delay the implementation of the International Classification of Diseases, 10th Edition, diagnosis and procedure code (ICD-10) from October 1, 2013 to October 1, 2014. The proposed rule is in response to providers’ concerns about meeting HHS’ compliance deadline for Version 5010 HIPAA standards for electronic health care transactions. Compliance with Version 5010 is necessary prior to implementation of ICD-10. Comments on the proposed rule are due by May 17, 2012.
The Medicare and Medicaid programs provide health insurance for tens of millions of people. According to Centers for Medicare and Medicaid Services (CMS), the Medicare program alone has 47.5 million beneficiaries and, in 2010, had total expenditures of $523 billion. It is not surprising, therefore, that such large programs invite scrutiny from government auditors and their contractors seeking to safeguard the Medicare Trustfund. Below is a brief description of some of the auditing contractors: Continue reading » |
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