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MCIT Breakthrough Devices Program Coverage Delayed

On May 14, 2021, CMS issued a new final rule that will further delay the effective date of the Medicare Coverage of Innovative Technology MCIT and Definition of Reasonable and Necessary Final Rule until no earlier than Dec. 15, 2021. ....

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ZPIC Audits: What Healthcare Providers Need to Know | Oberheiden P.C.

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Zone Program Integrity Contractors (ZPICs) are federal contractors that work under the direction of the Centers for Medicare and Medicaid Services (CMS) to uncover fraudulent billings under Medicare. ZPICs have broad authority to conduct audits of Medicare-participating healthcare providers; and, following audits, ZPICs can directly impose sanctions and/or refer providers to CMS or the U.S. Department of Justice for further enforcement action.
Technically, ZPICs are tasked with identifying both overpayments and underpayments. Their “integrity” function is intended to ensure that both CMS and the providers that bill Medicare achieve fair outcomes. However, as “fee for service” contractors working with CMS, ZPICs are only financially incentivized to identify overpayments and seek recoupments, and this means that ZPIC audits usually only focus on determining whether these contractors can lodge accusations o ....

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Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January Through March 2021

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances–January Through March 2021
Health & Human Services Department & Publications
Agency:
SUMMARY: This quarterly notice lists CMS manual instructions, substantive and interpretive regulations, and other
Federal Register notices that were published from January through
March 2021, relating to the Medicare and Medicaid programs and other programs administered by CMS.
FOR FURTHER INFORMATION CONTACT: It is possible that an interested party may need specific information and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing contact persons to answer general questions concerning each of the addenda published in this notice: ....

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Medicare Coverage Breakthrough Delayed | King & Spalding

Medicare Coverage Breakthrough Delayed | King & Spalding
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Individual Prosecutions Down But Corporate Resolutions Steady For DOJ's Fraud Section In 2020, With More In The Pipeline - Food, Drugs, Healthcare, Life Sciences

LITIGATION DEVELOPMENTS
Individual Prosecutions Down But Corporate Resolutions Steady
for DOJ s Fraud Section in 2020, with More in the Pipeline
The Department of Justice s ( DOJ ) Fraud Section
recently released a year-in-review report that shows the
section s strong performance in 2020, despite challenges caused
by the global pandemic. Although individual prosecutions were down
approximately 30% from 2019, the number of corporate resolutions
remained steady. The report also emphasizes the section s rapid
response to fraud in connection with the Paycheck Protection
Program and highlights one of the largest-ever National Health Care
Fraud and Prescription Opioid Takedowns.
In 2020, the Fraud Section charged 326 individuals across its
three litigation units: the Foreign Corrupt Practices Act ....

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