Although capped, more plaintiffs are expected to be included in a second lawsuit. EDITOR’S NOTE: Virginia Gov. Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Sept. 25, claiming that more than a dozen of the state’s Medicaid behavioral…
To understand the difference it is helpful to know the regulatory hierarchy. Last week’s article describing how Local Coverage Determinations (LCDs) are not binding prompted a question: what about National Coverage Determinations (NCDs)?  Are NCDs afforded more weight than LCDs? The answer is a resounding “yes.” NCDs are binding, but…
As a Medicare/Medicaid healthcare provider, you have a property right to your reimbursements for services rendered that were medically necessary. Why does it matter if your Medicare or Medicaid reimbursements constitute property rights? If you have a property right to something, it cannot be taken from you without due process…
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…
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…
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,…
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…
Refund only after careful thought. The risk of rushing to refund: not only is it alliterative, it is real. The proper desire to be compliant can prompt a hasty decision to return money to the government. While it is both wise and necessary to return overpayments to Medicare and Medicaid,…
The Low Income Pool or “LIP” is a funding pool designed to support health care providers that provide uncompensated care to Florida residents who are uninsured or underinsured.  There are multiple states with similar programs. CMS approved the LIP in 2005 as part of a section 1115 demonstration project (usually…