Tag archive: medicaid

Delays in Illinois Medicaid Approval Under Fire

As every long-term care facility doing business in Illinois can attest, Medicaid eligibility determinations and benefit awards have been slow, with HFS often falling months, if not years, behind. A group of SNFs and their residents are trying to change that. Several healthcare providers and their patients have filed suit against Felicia Norwood in her…

CMS Final Rule – Completed Comprehensive Analysis by Sandberg Phoenix LTC Team

The past few weeks have been busy ones for the Sandberg Phoenix & von Gontard Long-Term Care and Senior Living team as we have collectively analyzed and blogged about each of the revisions to the federal nursing home regulations. These revisions to 42 CFR 483(B) are the first comprehensive updates since 1991 and address the…

Section 483.15 Admission, Transfer and Discharge Rights

Implementation Date: November 28, 2016¹ Section 483.15 replaces section 483.12 and requires the facility to establish an admissions policy. Section (a)(2) states facilities cannot request or require residents or potential residents to waive their rights to Medicare or Medicaid benefits or any rights conferred by applicable state, federal and local licensing or certification laws. Section(a)(2)(iii)…

CMS Final Rule – Section 483.70 Administration

Implementation Date: Phase 1 – November 28, 2016 Perhaps the greatest attention of the CMS final rule changes has focused on the arbitration provision (§483.70(n)). Beginning November 28, 2016, all facilities enrolled in the Medicaid and Medicare program are prohibited from entering into pre-dispute arbitration agreements with any resident or resident’s representative. This provision creates…

CMS Final Rule – Comprehensive Analysis by Sandberg Phoenix LTC Team

Over the next few weeks, the Sandberg Phoenix Long-Term Care and Senior Housing Team will be rolling out its analysis of the new CMS Final Rule revising the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. We will address each revision and how it impacts both the care…

New Final Rule for National Emergency Preparedness for Medicare/Medicaid Providers & Suppliers

Following recent natural disasters, such as Hurricane Sandy or episodes of serious flooding; the Centers for Medicare and Medicaid Services (CMS) published a Final Rule to help Medicaid & Medicare providers and suppliers plan for natural and man-made disasters. The new regulations provide consistent emergency preparedness requirements with a goal of enhancing patient safety during…

CMS Issues Proposed Rule to Overhaul Part B Drug Payments

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule to reduce Medicare expenditures by changing the way it makes payments for Part B drugs. The proposal includes two phases. The first involves changing the percent of add-on to the Average Sales Price (ASP) of the drugs from 6% to 2.5% plus…

HEAT Settlement Resolves Alleged Inducement of Medicare and Medicaid Business

Next time you wonder how seriously the Department of Justice (DOJ) and its Health Care Fraud Prevention and Enforcement Action Team (HEAT) takes fraud and abuse, be assured they are very serious. This recently announced settlement arose from allegations the DOJ received from a whistleblower that Rite Aid provided gift cards to Medicaid and/or Medicare…

Health Care Providers Beware – Overpayment Claim News

Two recently announced settlements with Washington State and the Federal government show two potential overpayment issues for providers. Molina Healthcare of Washington, Inc., announced in an SEC filing on September 5th, that it agreed in principle with the Washington Health Care Authority (HCA) to settle the two outstanding overpayment matters brought by HCA demanding recoupment…

Learning the Hard Way – Omnicare to Pay $124M False Claims Settlement

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it. The Department of…

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