CMS proposes changes to PACE designed to modernize program

The Centers for Medicare and Medicaid (CMS) is proposing a number of changes to the regulations that control the Programs of All-Inclusive Care for the Elderly. PACE, as it is known, allows seniors, most of whom are eligible for Medicare and Medicaid, to live and receive care at home instead of in a skilled nursing […]

States’ failure to implement NCCI edits cost Medicaid program billions annually

Improper payments to healthcare providers cost the Medicaid program approximately $17.5 billion in fiscal year 2014, according to a new report from the HHS Office of the Inspector General. The reason: States’ failure to fully implement or properly use Medicaid National Correct Coding Initiative (NCCI) edits. The purpose of the NCCI edits is to prevent […]

CMS clarifies 60-day overpayment rule

The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule that details the reporting and returning of Medicare Part A and B overpayments. The proposed rule left providers asking many questions. The final rule provides needed clarity and consistency in the reporting and returning of self-identified overpayments. It is designed to […]

How whistleblowers are helping to fight healthcare fraud

Earlier this month, the Department of Justice announced it had resolved a $237 million judgment against Toumey Healthcare System in South Carolina for violations of the Stark Law. In this particular case, the hospital was alleged to have entered into contracts with 19 specialists that required them to refer their outpatient procedures to the hospital […]

CMS unveils proposed rules for Medicaid managed care plans

On May 26, The Centers for Medicare & Medicaid Services (CMS) released its long-awaited proposed rule, updating its Medicaid managed care organization regulations. The proposal is designed to “better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing […]

GAO: Government misspent billions on Medicare/Medicaid

Last year, Medicare financed health services for approximately 54 million elderly and disabled beneficiaries at a total cost of $603 billion. Of that, approximately $60 billion went toward improper payments, according to a report issued last week by the Government Accountability Office (GAO) Most of that misspent money, about $45.8 billion, went toward the Medicare […]

HHS proposes new safe harbors

The U.S. Department of Health and Human Services has proposed a rule that would amend the safe harbors to the anti-kickback statute and the civil monetary penalty rules under the authority of the Office of Inspector General. The 94-page proposed rule, if adopted would add new safe harbors and codify civil monetary provisions for gain […]

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