New case law supports due process for Medicare providers. Due process is one of the cornerstones of our society. Due process is the universal guarantee and found in the Fifth Amendment to the United States Constitution, which provides "No person shall…be deprived of life, liberty, or property, without due process…
New RAC targets are being proposed by CMS as the agency seeks to consolidate Medicare audits. You have to stay on your toes when you deal with Recovery Audit Contractors (RAC) audits— not to mention all the other types of regulatory audits that health care providers undergo. This article investigates…
Pending a possible government shut down, this bill would allow documentation from a home health agency to be considered when records are reviewed.  Late on Feb. 5, the U.S. House of Representatives introduced a “bipartisan” bill to avoid another government shutdown. While the big healthcare news of this bill was…
A False Claims Act case pits a prominent health system against its EHR software provider. Over the last many years, healthcare providers have been financially incentivized to purchase electronic health records (EHR) software. These programs can cost upwards of $25,000 to $50,000, and, sometimes are renewable every year. In other…
The guy either has no idea how the process works or he has mastered the art of lying with statistics. In May 2014, the American Hospital Association (AHA) sued the Secretary of Health and Human Services (HHS) in an attempt to force the government to do something about the ridiculous…
The OIG has added specialty drug coverage and reimbursement by Medicaid to its Work Plan.  In October, the OIG added specialty drug coverage and reimbursement by Medicaid to the list of active Work Plan items. This was in addition to the continuing Medicaid-related prescription drug reviews for the 2017 fiscal…
CMS has posted three new issues the RACs have proposed for auditing, pending CMS evaluation and approval. Last week the Centers for Medicare & Medicaid Services (CMS) created a new page on its Recovery Audit Contractor (RAC) website titled Provider Resources. CMS indicated that it will post on this page…
Late last week a case management colleague distributed an insurance company memo that had been sent to her hospital to a Recovery Audit Contractor- (RAC)-related user group. This memo required a double-take to ensure that it was not five months old, because it should have been distributed on April Fools’…
In the 1934 movie “Death Takes a Holiday,” Death, played by the venerable Fredric March, takes a three-day holiday to find out why everyone fears him. During his respite, no one dies from disease or accidents. Unlike in the movie, in real life Death doesn’t go on vacation but works…
Recent articles have described the regulatory complexity surrounding signatures and credentials in the world of healthcare. There’s a practical question associated with this: How do you train people to comply with a best practice without mischaracterizing the state of a law?  This question is really important. Perhaps my favorite activity as a lawyer…
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