Ashley Morgan

Veterans Administration and CMS Announce Partnership to Address Fraud Prevention

Medicare, Medicaid & Private Payor Updates /

(January 25, 2018): On January 23rd, the Veteran Administration (VA) and the Centers for Medicare and Medicaid Services (CMS) announced a “partnership to strengthen prevention of fraud, waste and abuse.” According to the press release, under this partnership: “VA plans to capitalize on the advancement in analytics CMS has made by concentrating on its use […]

Veterans Administration and CMS Announce Partnership to Address Fraud Prevention Read More »

Michael Cook appointed to serve on Virginia’s Medicaid Policy Council

Firm News /

(January 2, 2018):  Congratulations to our very own Michael Cook who has been appointed to serve on the Virginia Medicaid Policy Council for Health and Human Resources. In this role, The Council’s role is to provide recommendations on policy issues involving the programs operated by the Department of Health and Human Resources as part of the transition.

Michael Cook appointed to serve on Virginia’s Medicaid Policy Council Read More »

OIG And DOJ Issue Important New Compliance Guidance

Compliance, Medicare, Medicaid & Private Payor Updates /

Compliance Guidance (April 14, 2017) Recently, the Office of Inspector General of the United States Department of Health and Human Services (OIG) and the Criminal Division of the Fraud Section at the United States Department of Justice (DOJ) have issued guidance on measuring the effectiveness of corporate compliance programs.  In February, DOJ placed on its

OIG And DOJ Issue Important New Compliance Guidance Read More »

HHS Issues Final Rule to Address Record High Medicare Appeals Backlog

Medicare, Medicaid & Private Payor Updates /

(January 20, 2017): The Medicare appeals backlog has reached its all-time worst. If you’re a healthcare provider or supplier waiting for a hearing before an Administrative Law Judge (ALJ) at the Office of Medicare Hearings and Medicare Appeals (OMHA) – the third level of the Medicare appeals process – you’ve likely been waiting years to

HHS Issues Final Rule to Address Record High Medicare Appeals Backlog Read More »

It’s Time for CMS and Congress to Review Outdated Medicare and Medicaid Provisions

Firm News /

(November 23, 2016): Michael Cook, co-chair of the Health Care Group, has an article published in the October issue of the American Health Lawyers Association Journal of Health Law & Life Sciences entitled “It’s Time for CMS and Congress to Review Outdated Medicare and Medicaid Provisions.” The article discusses the fact that given the dramatic

It’s Time for CMS and Congress to Review Outdated Medicare and Medicaid Provisions Read More »

CMS Seeks to Overhaul Medicare Claims Appeal Process

Medicare, Medicaid & Private Payor Updates /

(July 18, 2016): The Centers for Medicare and Medicaid Services (CMS) has announced a series of proposed changes to the Medicare claims appeal process. The new rules primarily impact the Administrative Law Judge (ALJ) level of review, and CMS has indicated that the purpose of these changes is to help reduce the backlog of pending

CMS Seeks to Overhaul Medicare Claims Appeal Process Read More »

CMS Announces Home Health Pre-Claim Review Demonstration Project for Five States

Home Health & Hospice /

(July 5, 2016) The Centers for Medicare and Medicaid Services (CMS) has announced a home health pre-claim review demonstration project to be initiated in five states. According to CMS, the purpose of the new project is to prevent improper Medicare payments, enhance quality of care, and deter waste, fraud, and abuse in the Medicare program.

CMS Announces Home Health Pre-Claim Review Demonstration Project for Five States Read More »

CMS Expands ALJ Appeal Claim Settlement Process to Include Part A Providers

Medicare, Medicaid & Private Payor Updates /

(April 4, 2016) In an effort to reduce the enormous backlog of pending Administrative Law Judge (ALJ) appeals, the Centers for Medicare and Medicaid Services (CMS) recently announced that it has expanded the pilot Settlement Conference Facilitation (SCF) process to include Part A claims. This process, which was previously only available to providers with pending

CMS Expands ALJ Appeal Claim Settlement Process to Include Part A Providers Read More »

Home Health HIPAA Violation Costs $239,800!

Home Health & Hospice /

(March 29, 2016) Lincare, Inc., a provider of respiratory care, infusion therapy and medical equipment to in-home patients, will pay $239,800 in Civil Money Penalties (CMPs) for violating the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule after a HHS Administrative Law Judge (ALJ) ruled in favor of the Office for Civil Rights (OCR).

Home Health HIPAA Violation Costs $239,800! Read More »