EDITOR’S NOTE: This RACmonitor series examines a new type of auditing in healthcare – the use of algorithms. In the first article in this series, “Artificial Intelligence is Coming to Medicare Audits – Is Your Legal Team Obsolete?” Mr. Roche reported on statistical sampling being supplanted by more complex methods…
A preliminary injunction has been filed in federal courts to halt the termination of two dozen Virginia behavioral healthcare providers. There are some updates on the matter of A Village Youth and Family Services, Inc., et al v. The Commonwealth of Virginia et al, through which more than two dozen…
More than 700 pages of text make up proposed changes to the federal Stark and anti-kickback statutes. On Wednesday, Oct. 9, federal healthcare officials announced two new proposed rules.  While the main focus of both proposals is to remove perceived legal barriers to various value-based reimbursement models and facilitate care…
The proposed changes target the federal Physician Self-Referral Law and the Anti-Kickback Statute. The U.S. Department of Health and Human Services (HHS) is introducing proposed changes to “modernize and clarify” the regulations that interpret the Physician Self-Referral Law (the “Stark Law”) and the federal Anti-Kickback Statute, officials announced Wednesday. The…
The nonprofit news service alleges the federal government violated the Freedom of Information Act by refusing to disclose documents reflecting risk adjustment validation data. Kaiser Health News (KHN) has filed a federal lawsuit against the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human…
An ad campaign opposing the move is raising eyebrows nationwide. We’re more than halfway into September, but if you’re like me, it feels like 2019 is already over. It doesn’t feel like I’ll have enough time to finish everything I was supposed to before the end of the year. Congress…
More than two dozen providers are listed as plaintiffs, with more expected to join.   More than two dozen Virginia behavioral healthcare providers have filed a preliminary injunction in federal court to halt and reverse their recent sudden, unexpected dismissal from the state’s Medicaid ranks at the hands of six…
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…
HHS OIG uncovered irregularities in 2016 reimbursements. Payments for hospice services were in the news this week, with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reporting that the Centers for Medicare & Medicaid Services (CMS) had repeatedly paid twice for such services during…