Showing 73 posts in Medicare/Medicaid.
The IRS Provides Temporary Relief for Certain Health Reimbursement Arrangements
On February 18, 2015, the Internal Revenue Service (“IRS”) provided further guidance related to the issue of how certain employer health insurance reimbursement arrangements are treated under the Affordable Care Act (“ACA”).
As we explained in a previous post, after the Health Insurance Marketplace opened for business, many employers recommended that their employees use it to purchase individual health insurance policies, with the promise that the premium costs would be reimbursed by the employer. In fact, such employee reimbursement strategies were aggressively marketed to employers as a solution to reduce costs and comply with the requirements of the ACA. Little did these employers (and marketers) know, such arrangements exposed the employers to significant penalties under the ACA.
Prior guidance made clear that such arrangements – whether funded on a pre- or post-tax basis – may be subject to the ACA’s market reforms. Employers that offer reimbursement arrangements that violate the ACA are subject to a $100 per day per affected employee penalty.
Notice 2015-17 clarifies previous guidance and provides transition relief to certain small employers from ACA penalties. Key aspects of the new guidance are noted below. Read More ›
Categories: Compliance, Employee Benefits, Health Care Reform, Health Insurance Exchange, Medicare/Medicaid, Tax
Share
2015 Michigan Health Law Update
On March 12, 2015 Foster Swift Attorney Jennifer Van Regenmorter co-presented the Michigan Health Law Update (“Annual Update”) at the 21st Annual Health Law Institute. The Annual Update provides an overview of the most significant Michigan-specific health law developments from the past year, many of which have been covered on this blog. This article will summarize the highlights from this year’s Annual Update. Read More ›
Categories: Hospitals, Insurance, Licensing, Medicare/Medicaid, News & Events, Privacy
“Top 10 Healthcare Law Trends in 2015” – Part 2
The February issue of the American Health Lawyers Association’s AHLA Connections features a list of the top ten issues that will impact healthcare law in 2015. We summarized the first five topics in a previous blog. (Miss our summary of the first five? Please click here.)
Here are the remaining trends to think about: Read More ›
Categories: Health Care Reform, HIPAA, Medicare/Medicaid, News & Events, Providers
“Top 10 Healthcare Law Trends in 2015” – Part 1
The February issue of the American Health Lawyers Association’s AHLA Connections features a top-ten list of the issues that will impact healthcare law in 2015. This two-part series discusses these important trends.
Here are the first five: Read More ›
Categories: Fraud & Abuse, Health Care Reform, Medicare/Medicaid, News & Events
Supreme Court to Weigh in on Providers’ Rights to Sue for Medicaid Reimbursements
The Medicaid program, a public insurance program serving approximately 66 million low-income Americans, is at risk for losing participating providers who claim they are not being compensated fairly for their services. On January 19, 2015, the Supreme Court heard arguments in Armstrong v. Exceptional Child Center, a case that could impact the rights of healthcare providers to sue states for higher Medicaid payments. Five private companies brought suit against the director of Idaho’s health department, arguing that the state unfairly reimbursed them at rates set in 2006, despite the fact that higher rates have since been approved by the Centers for Medicare and Medicaid Services (“CMS”).
Federal law provides that state Medicaid programs must ensure payments are “sufficient to enlist enough providers,” but states have discretion to decide what that means. 42 U.S.C. § 1396a(a)(30)(A) (the “Medicaid Statute”). Central to this case is whether providers have a cause of action that allows them to seek enforcement of a federal statute. Read More ›
Categories: Insurance, Medicare/Medicaid, Providers
Pioneer ACO Results Present a Fuller Picture of the Program's Promise
Accountable Care Organizations (ACO) are still a relatively new concept in the healthcare world. ACOs emerged in 2011 as a result of an initiative by the Centers for Medicare & Medicaid Services (CMS), as we documented in our blog articles ACO Regulations Finally Released, Braving the New Frontier of Accountable Care Organizations, and Final ACO Regulations are Released - Is this the Beginning of a New Era for Health Care?
While what exactly is an ACO is still kind of nebulous, ACOs generally are groups of doctors, hospitals, and other health care providers, who voluntarily join forces for the purpose of providing coordinated care to Medicare patients. The goal of ACO’s coordinated care is to ensure that patients, especially the chronically ill, receive the correct care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. ACOs that achieve cost saving from providing timely and accurate care that meet quality benchmarks share in Medicare savings. Lofty and worthy goals, no doubt. Read More ›
Categories: Accountable Care Organizations, Medicare/Medicaid
Michigan Supreme Court Refuses to Reconsider its Decision to Reject Class Action Against Pharmacies for Allegedly Overcharging Medicaid for Generic Prescription Drugs
On August 5, 2014, the Michigan Supreme Court (the "Court") declined to reconsider its decision to reject two class actions and a qui tam action against CVS Caremark Corporation, Rite Aid of Michigan, Inc., and several other pharmacies. The lawsuits were based on allegations that the companies had overcharged Medicaid for generic prescription drugs.
The underlying case was argued before the Court on January 16, 2014, and the Court ruled against the plaintiffs on June 11, 2014. The plaintiffs argued that the pharmacies violated Michigan Public Health Code, MCL 333.17755(2), which requires a pharmacist to “pass on the savings in cost” when dispensing a generic drug instead of a brand name drug. Read More ›
Categories: Medicare/Medicaid, Pharmacy
CMS Proposed Rule Affecting Home Health Agencies
The Centers for Medicare & Medicaid Services ("CMS") recently
announced proposed changes to the Medicare home health prospective payment
system (“PPS”) for the 2015 calendar year. CMS is proposing to tighten eligibility
requirements for home health services
and set a minimum requirement on Home Health Agencies ("HHAs") to
prove their effectiveness, as well as revise how much CMS will pay for certain
services. These proposed changes are expected to reduce Medicare payments to
HHAs by $58 million next year alone, a reduction of .30 percent.
To qualify for the Medicare home health benefit, a beneficiary must be under the care of a physician, have a need for skilled nursing care, physical therapy, speech-language pathology, or continued need for occupational therapy. Further, the beneficiary must be homebound and receive home health services from a Medicare approved agency.
The proposed changes include the following: Read More ›
Categories: Health Care Reform, Medicare/Medicaid
Planning for CHOWs of Home Health Agencies and the 36-Month Rule
Due to regulatory and reimbursement constraints, health care providers are increasingly merging, affiliating, and acquiring other health care entities. In these transactions, the Medicare providers must identify whether a Medicare change of ownership (“CHOW”) will occur. Although it may appear, from a business standpoint, that a change of ownership will occur, the transaction may not necessarily be considered a CHOW for Medicare. Essentially, if the person or entity with ultimate responsibility for the provider changes, typically there will be a Medicare CHOW. Sometimes, but not always, this will be indicated by whether there has been a change in the taxpayer identification number.
CHOWs impact the Medicare provider agreement involved in the sale. Unless the buyer takes steps to affirmatively reject the seller's provider agreement, in a Medicare CHOW, the seller's provider agreement is automatically assigned to the buyer. This provides billing advantages for the buyer without having to enroll as a new Medicare provider, go through the initial enrollment process, and be re-surveyed or re-accredited, which takes several months. Read More ›
Categories: Compliance, Medicare/Medicaid, Providers
Cracking Down on Fraud and Waste: OIG Releases Recommendations to Increase HHS Program Efficiency
In March of 2014, the Office of the Inspector General ("OIG") released the "OIG Compendium of Priority Recommendations." The recommendations offered are designed to help current programs for the Department of Health and Human Services ("HHS") run more effectively. The recommendation discussed twenty-five "opportunities" which, if addressed, would help to eliminate fraud and waste among HHS programs. The “opportunities” include the following: Read More ›
Categories: Compliance, Fraud & Abuse, Medicare/Medicaid, Providers
Categories
- HIPAA
- Medicare/Medicaid
- Audits
- Did you Know?
- Technology
- Fraud & Abuse
- Regulations
- Legislative Updates
- News
- Cybersecurity
- Medicaid Planning
- COVID-19 and Workers' Compensation
- Contracts
- Licensing
- Lawsuit
- Digital Assets
- Employment
- Long-Term Care
- Health Care Reform
- Employee Benefits
- News & Events
- Hospitals
- Pharmacy
- Affordable Care Act
- Privacy
- Providers
- Insurance
- Billing/Payment
- Retirement
- Medicare
- Hospice
- Criminal
- HITECH Act
- Electronic Health Records
- Physicians
- Regulatory
- Tax
- Accountable Care Organizations
- Patents
- Department of Labor
- Compliance
- Labor Relations
- Alerts and Updates
- 6th Circuit Court of Appeals
- Health Insurance Exchange
- Workers' Compensation
Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.