Page 143 - Medicare Program News Today

Feds find 3 SC parties accountable for $114 million healthcare fraud scheme Floyd Calhoun “Cal” Dent, III, of Lexington, and his two co-conspirators will continue to be held liable for defrauding Medicare and Tricare. (Source: Gray News) By Riley Bean | March 8, 2021 at 11:51 AM EST - Updated March 8 at 11:51 AM CHARLESTON, S.C. (WCSC) - The US Attorney for the District of South Carolina says the court of appeals has affirmed their $114 million judgement against one man and two testi...

Value-based arrangement means an arrangement for the provision of at least one value-based activity for a target patient population to which the only parties are—(1) the value-based enterprise and one or more of its VBE participants; or (2) VBE participants in the same value-based enterprise.” As previously noted, only “compensation arrangements” (and not ownership or investment arrangements) qualify as “value-based arrangements” for purposes of the new value-based exceptions. Furt...

[6] “Medicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other Facilities (PDF)” [7] MLN Matters article. 1 “Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly,” Fast Facts, Medicare Learning Network, Centers for Medicare & Medicaid Services, December 21, 2020, http://go.cms.gov/3ivCwRe. 2 Amy J. Frontz, “Medicare Made $11.7 Million in Overpayments for Nonphysici...

To embed, copy and paste the code into your website or blog: On January 14, 2021, CMS finalized a regulatory definition for determining whether an item or service is "reasonable and necessary" for Medicare coverage purposes. Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of "Reasonable and Necessary," 86 Fed. Reg. 2987 (Final Rule, January 14, 2021). In response to President Trumps October 3, 2019 Executive Order 13890 directing the Secretary of HHS to clarif...

To embed, copy and paste the code into your website or blog: In Advisory Opinion No. 20-05, posted September 23, 2020, OIG was unwilling to approve a pharmaceutical companys proposed cost-sharing subsidy program for beneficiaries seeking to use its expensive new drug for treatment of a rare cardiovascular disease. While OIG stated it was not in a position to reach a definitive conclusion regarding whether a violation of the federal Anti-Kickback Statute (AKS) existed, OIG was unwilling to issue...

“Full Financial Risk” A. Overview of Key Safe Harbors and Exceptions An important initial consideration is that there are multiple differing requirements between corresponding Stark Law exceptions and AKS safe harbors. Stakeholders must navigate the requirements under both regulatory regimes for arrangements that potentially implicate each law. Although a number of commenters sought a unified set of requirements between Stark Law and AKS requirements, CMS and OIG rejected this approach, not...

Tuesday, February 2, 2021 On 2 December 2020, the U.S. Department of Health and Human Services’ (HHS) issued two Final Rules in conjunction with its “Regulatory Sprint to Coordinated Care,” which will markedly change the regulatory fraud and abuse landscape for “value-based” arrangements: (i) The HHS Office of the Inspector General (OIG) published a Final Rule that introduces new safe harbor protections under the federal Anti-Kickback Statute (AKS) for certain coordinated c...

Monday, January 25, 2021 CMS just issued a correction to its guidance on 2021 Medicare rules for remote physiologic monitoring (RPM) services. The correction is effective January 1, 2021 and revises the preamble commentary in the Medicare Physician Fee Schedule Final Rule, previously published on December 1, 2020. It adds language that was inadvertently deleted from the Final Rule, summarizing and responding some public comments. Here is a summary of the new changes: 20 Minutes of...

Thursday, December 31, 2020 In our December 7, 2020 Blog Post, “Permanent Expansion of Medicare Telehealth Services,” we discussed the 2021 Medicare Physician Fee Schedule Final Rule (the “Final Rule”) and the regulatory changes made therein by the Centers for Medicare and Medicaid Services (“ CMS”) to expand Medicare telehealth coverage within the confines of existing Medicare statutory law.  The Final Rule was first posted on December 2, 2020 and was formally published ...

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