By Deniza Gertsberg, Esq., on November 1st, 2016 The Office of Civil Rights (OCR) within the U.S. Department of Health and Human Services, recently issued a Non-discrimination in Health Care Programs and Activities rule. This final rule implements Section 1557 of the Patient Protection and Affordable Care Act (ACA). Section 1557 builds on existing civil rights laws and prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities and applies broadly to many providers and suppliers.
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By Deniza Gertsberg, Esq., on September 29th, 2016 The passage of the Patient Protection and Affordable Care Act (ACA) heralded a new era for provider enrollment and revalidation by enhancing provider and supplier screenings. The Centers for Medicare & Medicaid Services (CMS) now requires certain providers to be fingerprinted in order to continue participating in the Medicare program. Medicare contractors (MACs) have been
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By Deniza Gertsberg, Esq., on August 3rd, 2016 The Affordable Care Act (ACA) heralded a new era of provider enrollment screenings not only in the Medicare program but also in States’ Medicaid programs. A series of new Office of Inspector General (OIG) reports reviewed the effectiveness of the States’ implementation of the new screening requirements in the Medicaid programs and found areas in need of improvement.
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By Deniza Gertsberg, Esq., on July 5th, 2016 The Centers for Medicare & Medicaid Services (CMS) views the enrollment process as an important gatekeeping tool for preventing fraud, waste and abuse. The passage of the Affordable Care Act (ACA) enhanced the ability of CMS to further this goal. Recently, the Office of the Inspector General (OIG) published a report analyzing the effectiveness of certain enhanced provider enrollment screenings.
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By Deniza Gertsberg, Esq., on July 2nd, 2015 The Centers for Medicare & Medicaid Services (CMS) published full year of 2014 financial data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.
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By Deniza Gertsberg, Esq., on July 16th, 2014 The Centers for Medicare & Medicaid (CMS) is proposing rule changes to streamline the implementation of the Sunshine Act.
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By Deniza Gertsberg, Esq., on June 26th, 2014 Pursuant to the requirements imposed by the Affordable Care Act (ACA), New Jersey Division of Medical Assistance and Health Services is beginning a revalidation process of all NJ FamilyCare (NJFM) fee-for-service (FFS) providers.
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The Centers for Medicare & Medicaid Services (CMS) announced that it will begin implementing the fingerprint-based background checks for providers and suppliers in certain risk categories.
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By Deniza Gertsberg, Esq., on October 20th, 2013 Section 6002 of the Affordable Care Act requires manufacturers of pharmaceuticals, biologicals, medical devices or supplies to publicly report payments made to physicians and teaching hospitals. This article reviews some of the implications the new requirement has on physicians and their relationships with the industry.
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By Deniza Gertsberg, Esq., on September 17th, 2013 The NYS Medicaid recently informed referring and servicing providers that, effective for services provided on and after October 1, 2013, claims will be denied if they include the NPI of non-enrolled ordering, prescribing, referring or attending provider (OPRA). Below we discuss some of the changes.
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By Deniza Gertsberg, Esq., on August 1st, 2013 Medical space leasing requires more consideration and deeper analysis than typical commercial leases. Various federal and state laws regulate financial relationships of medical providers which in turn dictate the terms of a lease.
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By Deniza Gertsberg, Esq., on August 8th, 2012 One of the changes brought about by the Affordable Care Act (ACA) is the enhanced enrollment and revalidation screenings for providers and suppliers not only under Medicare but also Medicaid and CHIP healthcare programs.
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By Deniza Gertsberg, Esq., on August 30th, 2011 In the last few years, many healthcare providers have come under increased scrutiny from federal and state investigative and auditing agencies. The recent USAToday article confirms that the federal government stepped up the prosecution of health care fraud. In fact, according to USAToday “[n]ew government statistics show federal health care fraud prosecutions in the first
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