Articles and Blogs

In a surprise reversal, the Centers for Medicare & Medicaid Services (CMS) has dropped a controversial proposed regulation that would require nursing homes to hire independent pharmacists to oversee residents’ medication regimens. The proposed rule had been developed in response to the belief that relationships between long-term care providers and pharmacy suppliers could conflict... READ MORE

As part of their on-going video series, the Office of Inspector General (OIG) has posted a video on their self-disclosure protocols. Self-disclosure is a key element of an effective compliance program, and can possibly reduce any civil monetary penalties (CMPs) associated with a violation or instance of noncompliance. The OIG has provided many videos... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012.   READ MORE

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that enacts a provision of the Patient Protection and Affordable Care Act (PPACA) that seeks to make Medicaid reimbursement for medications more transparent and more closely aligned with what pharmacies pay for the drugs.  In a press release, CMS states the... READ MORE

The Department of Justice (DOJ) has recommended to the Supreme Court of the United States (SCOTUS) that only the provisions of the Patient Protection and Affordable Care Act (PPACA) that require insurers to accept everyone regardless of health status and to apply “community rates” be overturned if the Justices rule that the law’s mandate... READ MORE

The Centers for Medicare & Medicaid Services (CMS) released updated guidance on Section 6501 of the Patient Protection and Affordable Care Act (PPACA) that requires state Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other state Medicaid plan.   READ MORE

In December, the Office of the Inspector General (OIG) released an initial series of videos aimed at providers that focus on compliance issues.  These videos are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative.  Health & Human Services Inspector General Daniel Levinson stated the videos are... READ MORE

The Centers for Medicare & Medicaid Services (CMS) has issued revisions to the process Home Health Agencies (HHA) must undergo prior to initial certification.  The revised process adds an additional review of enrollment criteria performed by the Regional Home Health Intermediary (RHHI) or Medicare Administrative Contractor (MAC).   READ MORE

The Department of Labor published a Notice of Proposed Rulemaking in late December aimed at giving the nation’s nearly two million home care workers minimum wage and overtime protections.  These workers have long been working  under an exemption from the Fair Labor Standards Act (FLSA) as “companion” employees.   READ MORE

On November 30, 2011, Daniel R. Levinson, Inspector General, appeared before the Special Committee on Aging, and testified regarding the Office of Inspector General’s (OIG) findings pertaining to the use of atypical antipsychotic drugs by nursing home residents. The OIG hired psychiatrists who are experts in treating elderly patients to review a sample of... READ MORE