News

The ruling marks a stinging rebuke of HHS efforts to steer some services from the hospital outpatient setting to physicians. A federal judge has ruled that a Centers for Medicare & Medicaid Services (CMS) final rule slashing Medicare payments for certain hospital outpatient clinical evaluation and management (E&M) services to…
As Virginia Medicaid behavioral healthcare providers are being terminated, the question remains, is it legal. EDITOR’S NOTE: The opinions expressed herein are exclusively that of the author and do not necessarily reflect that of RACmonitor. Virginia behavioral healthcare providers that accept Medicaid are under statewide blanket fire. Without warning or provocation,…
Since 2010, a total of 113 rural hospitals have closed in the U.S Last week I was honored to be the opening keynote for SEACAA 2019; the annual conference for the Southeastern Association of Community Action Agencies. More than 1,000 of these agencies are on the front lines of the…
Ruling focused on key hospice admission. Last week, the 11th Circuit (the federal appeals court for the Southeastern United States) issued a decision in the AsceraCare case.     We have been waiting for this decision since the case was argued two and a half years ago. The key question in…
A mass termination of Virginia’s behavioral healthcare providers is now underway by managed care organizations. More than 100 Medicaid behavioral healthcare providers in Virginia are being terminated without cause this week by managed care organizations (MCOs), according to Knicole Emanuel, a healthcare attorney. Emanuel, working in Richmond, believes the terminations…
Conspiracy ran for nearly 20 years, netting owner of assisted living and skilled nursing facilities $37 million. The primary orchestrator of what federal authorities called the most wide-reaching healthcare fraud scheme ever uncovered has been sentenced to 20 years in state prison – far short of the 30 years prosecutors…
CMS wants to identify bad actors -– even if they are or have been affiliated with a legitimate provider. On Sept. 5, the Centers for Medicare & Medicaid Services (CMS) issued a new final rule. There was not really a proposed rule to which comments and suggestions could be made;…
The appellate court reversed the decision of the ALJ. When you defend an overpayment finding by a Recovery Audit Contractor (RAC) or a termination of a Medicare/Medicaid contract, you present before an administrative law judge (ALJ)in an administrative court. Today I want to write about the strength or deference that…