A Dallas-area home health agency has secured a court order that allows it to continue receiving Medicare reimbursement while it awaits a hearing before an Administrative Law Judge (ALJ) to contest a multi-million dollar overpayment determination. On June 28, 2018, the U.S. District Court for the Northern District of Texas issued a preliminary injunction preventing…

The Centers for Medicare and Medicaid Services (CMS) recently issued a press release outlining several new initiatives designed to enhance Medicaid program integrity efforts. These initiatives include increasing audits of state claims for federal match funds and medical loss ratios, increasing audits of beneficiary eligibility determinations, and optimizing state claims and provider data. This announcement…

In a rare decision, a Federal District Court has largely set aside a multi-million dollar extrapolated Medicare overpayment. Cypress Home Care, Inc., a home health agency based in northeast Texas, successfully challenged the overpayment assessment in court after the Medicare Appeals Council had upheld it. The case is Cypress Home Care, Inc. v. Azar. Adam…

A recent analysis by ProPublica has found that almost 2,000 healthcare practitioners around the country, including physicians, nurse practitioners, and physician assistants, billed Medicare for the highest level of evaluation and management services (E&M) for established patients at least 90% of the time in 2015. These finding echo concerns of the HHS Office of Inspector…

The Centers for Medicare and Medicaid Services (CMS) has taken action to scale back the use of civil monetary penalties (CMPs) against nursing homes, such as skilled nursing facilities (SNFs) and nursing facilities (NFs), that are found to be non-compliant with Federal and / or state requirements. This represents a significant change in CMS’ enforcement…

In a notice published on May 31, 2018, the Centers for Medicare and Medicaid Services (CMS) announced that it intends to resume the pre-claim review demonstration program for home health services in five states. CMS had previously started to implement pre-claim review in several states in late 2016, but that roll out was postponed indefinitely…

The healthcare industry is one of the most tightly-regulated in the country. All types of healthcare providers, ranging from large health systems to single-physician practices, are subject to a complex web of federal and state regulations. And these regulations touch on virtually every aspect of a provider’s operations from patient safety to patient information privacy…

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