News

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…
Expect more aggressive reviews of materials beyond the three-day criteria. Today I want to talk about skilled nursing facility, or as we often call them, “SNF” stays. For this, I’d like to start at the beginning. I’ll go all the way back to the Social Security Act. The reason to…
Latest CMS effort is one of several new federal authorities.  EDITOR’S NOTE: Former CMS career professional turned healthcare IT authority reported these developments Tuesday during Talk Ten Tuesday. The Centers for Medicare & Medicaid Services (CMS) is taking a more proactive approach to reducing fraud and abuse in Medicare and…
The announcement is all but ensured to trouble providers already concerned about overreach. Federal healthcare oversight authorities have announced that they are expanding their “revocation and denial authorities” in an effort to enhance their efforts to fight waste, fraud, and abuse in the American healthcare system – marking a move…