"Nationwide Healthcare Lawyers"
(November 20, 2023): Medicare, Medicaid, and most private insurance plans cover hospice care and related services. To be eligible for hospice care,1 a patient must be certified as terminally ill and have a life expectancy of six months or less. In recent years, the hospice industry has exponentially grown, and the number of Federal, State …
Hospice Audit and Investigative Actions are Expected to Rise in 2024 Read More »
(May 20, 2022): Acupuncture audits and investigations by federal, state and private payors have greatly expanded in recent years. One of the most active players conducting acupuncture audits today is the U.S. Department of Veterans Affairs. (VA). It is worth noting that long before traditional Medicare even considered covering acupuncture services,[1] the VA made these …
VA Acupuncture Audits of Non-VA, Community Providers are Increasing Read More »
(May 12, 2022): Hospice agencies are again the focus of both state and federal investigators and prosecutors around the country. The number of hospice audits and investigations at both the state and federal levels have risen in 2022. This isn’t surprising given the ever-expanding level of beneficiary participation and cost of Medicare’s hospice benefit program. …
State and Federal Hospice Audit and Investigation Efforts are Expanding in 2022 Read More »
(September 28, 2020):Last September, CMS published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” [1] Among its many chan ges, the Final Rule significantly expanded the reasons that may be asserted by the Centers for Medicare and Medicaid Services (CMS) when revoking a health …
Home Health Revocation Actions by Medicare are Expanding Around the Country Read More »
(March 23, 2020): Until recently, personal care services, such as home health aides, were not covered under the Medicare program unless they were part of a skilled service where the beneficiary was homebound. However, beginning with calendar year 2019, the Medicare program has expanded the ability of plans that participate in the Medicare Advantage program …
Recent Developments in Personal Care & Community-Based Services in Medicaid and Medicare Read More »
(September 30, 2019): On September 5, 2019, the Department of Health & Human Services (HHS), Office of Inspector General (OIG) published an HHS-OIG Data Brief entitled “The Centers for Medicare & Medicaid Services Could Use Comprehensive Error Rate Testing Data To Identify High-Risk Home Health Agencies”[1] The purpose of OIG’s review was two-fold: First, OIG …
(August 7, 2019): This article further updates our articles of February 19th and April 9th on the announcement by CMS of the implementation of the new five year “Review Choice Demonstration Project’ in five states – Illinois, Ohio, Texas, North Carolina and Florida, and the start date for the Demonstration Project in Illinois. I. Background …
(April 9, 2019): This article updates our article of February 19 on the lifting by the Centers for Medicare and Medicaid Services (“CMS”) of the moratorium on the enrollment of new home health agencies in Florida, Illinois, Michigan and Texas, and the announcement by CMS of the implementation of a new five year “Review Choice …
(February 19, 2019): CMS has now ended, at least for the current time, the moratorium that it placed on the approval of new home health agencies. At the same time, home health providers that operate in Illinois, Ohio, North Carolina, Florida and Texas, and potentially other states within the Palmetto/JM jurisdiction (Alabama, Arkansas, Georgia, Indiana, …
(January 9, 2019): Despite real progress being made with respect to regulatory compliance, home health agencies, their owners, and affiliated health care professionals (such as referring / supervising physicians, therapists and staff) remain under strict government scrutiny. The government’s efforts to investigate and prosecute home health fraud cases have been especially evident in Texas. In …
Texas Prosecutors are Aggressively Targeting Criminal Home Health Fraud Read More »
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