How Can Providers Challenge Medicaid Underpayment After Armstrong v. Exceptional Child Care Center ?
On March 31, 2015, the United States Supreme Court issued its decision in Armstrong v. Exceptional Child Center. The decision is arguably one of the most important decisions to providers of services under Medicaid since the inception of the program in 1965. The decision, by a 5-4 vote, essentially held that there is no private right of action for providers, or arguably beneficiaries, to enforce Section 1902(a)(30)(A) of the Social Security Act, commonly referred to as the “equal access” provision, by challenging inadequate provider rates under Medicaid. Since providers had relied on the equal access provision as the basis for seeking relief from deficient rates the decision severely limits, if not eliminates, the use of federal courts as a forum for these disputes.
Supreme Court Applies Health Insurance Tax Credits Nationwide
By a 6 to 3 decision, on June 25th the U.S. Supreme Court interpreted the Affordable Care Act (ACA) to provide tax credits to individuals in States with Federal insurance Exchanges. The law will thus apply uniformly throughout the country, although 16 States and the District of Columbia have established their own Exchanges and the remaining 34 States have elected to have the Federal government create an Exchange for them.
Federal Anti-Kickback Statute: What Constitutes a Referral?
Under the federal Anti-Kickback Statute (Anti-Kickback Statute), what constitutes a “referral”? Notably, neither the term “referral” nor the term “referring” (as it is referred to in the law) are defined in the statute.
HHS-OIG Releases 2015 Mid-Year Update to Work Plan
The OIG plans to produce 193 reports in the near future, 65% of which will pertain to Medicare and Medicaid. Although the OIG likes to revisit topics and measure progress in fraud, waste, and abuse prevention, it has announced a variety of new topics of study.
Health Law ArticlesHow Can Providers Challenge Medicaid Underpayment After Armstrong v. Exceptional Child Care Center ? Supreme Court Applies Health Insurance Tax Credits Nationwide Federal Anti-Kickback Statute: What Constitutes a Referral? HHS-OIG Releases 2015 Mid-Year Update to Work Plan The Medicare Appeals Process is Broken Read More Posts From This Category
Dental Law ArticlesDentists Participating in the Medicaid Program Must Exercise Caution to Avoid False Claims Act Liability Medicaid Dental Audit: Exclusion Screening Issues Dental Fraud Settlement — $5.05 Million to be Paid by Oklahoma Dental Practice in Medicaid Case. Medicaid Dental Fraud: Is the State of Texas Partly to Blame? Investigations of Medicaid Dental Fraud in Texas Read More Posts From This Category
False Claims ActFalse Claims Act: Whistleblower Cases Have Continued to Rise Since the Passage of the Affordable Care Act
Number of whistleblowers on the rise (March 3, 2015): The federal False Claims Act... [Read more of this review]Dental Fraud Settlement — $5.05 Million to be Paid by Oklahoma Dental Practice in Medicaid Case.
(November 10, 2014): Dental fraud investigations and audits are becoming increasingly... [Read more of this review]OCR to Covered Entities, Business Associates: Encryption Is Your Best Defense against HIPAA Violations
(May 29, 2014) On April 22, 2014, the U.S. Department of Health and Human Services... [Read more of this review]Read More Posts From This Category
Business & Transaction ArticlesCloud Storage Providers & BAAs – Where is Your Data?
In a recent webinar presentation, I was asked whether I believed one of the many... [Read more of this review]OIG Proposes New Anti-Kickback Law Safe Harbors
(November 10, 2014): The U.S. Department of Health and Human Services Office of Inspector... [Read more of this review]The Dangers of Keeping Medical Records in the “Cloud”
(July 3, 2014): The growing trend of storing all kinds of data in the cloud comes... [Read more of this review]Read More Posts From This Category