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Showing 73 posts in Medicare/Medicaid.

HHS Changes Policy, Expands Coverage for Physical Therapy

coverage for physical therapyThe New York Times (We have identified that the following link is no longer active, and it has been removed) recently reported that the Health and Human Services Department ("HHS") is changing its stance regarding Medicare payments for physical and occupational therapy treatments.  Previously, coverage was only afforded for treatment that actually helped to improve a patient's condition. Read More ›

Categories: Medicare/Medicaid

CMS Finalizes Changes to Unnecessary, Obsolete, Counterproductive or Excessively Burdensome Regulations

cms finalizes changesOn May 7, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a Final Rule to reform Medicare regulations identified as “unnecessary, obsolete, counterproductive or excessively burdensome” to hospitals and other health care providers. The changes are part of the Obama administration’s “regulatory lookback” in connection with Executive Order 13563, “Improving Regulation and Regulatory Review.” The Final Rule makes a number of clarifications and revisions to policies set forth in both the May 16, 2012 final rule and the February 7, 2013, proposed rule. CMS estimates the reforms could save providers nearly $660 million annually and $3.2 billion over five years.

Below is a brief summary that highlights some of the issues CMS is attempting to address. Please refer to the Final Rule, or contact us, to explore the full extent of the changes in more detail. Read More ›

Categories: Compliance, Hospitals, Medicare/Medicaid, Providers, Regulatory

Michigan Allowed to Move Dual Eligibles to Managed Care

managed careApproximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.

A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges. Read More ›

Categories: Health Care Reform, Insurance, Medicare/Medicaid, Providers

Obama Administration Makes Changes to Medicare to Accommodate Same-Sex Marriages

Obama Administration Makes Changes to Medicare to Accommodate Same-Sex MarriagesOn Thursday, April 3, 2014, the Obama administration announced that it was taking steps to bring its Medicare rules in line with the United States Supreme Court's ruling in US v. Windsor. Specifically, the Department of Health and Human Services (“HHS”) announced that same-sex marriages would be recognized for determining Medicare entitlement and eligibility. Read More ›

Categories: Employee Benefits, Insurance, Medicare/Medicaid, Providers

Foster Swift Attorneys Attend Annual Health Law Institute

Foster Swift Attorneys Attend Annual Health Law InstituteFoster Swift health care attorneys are getting ready to attend the 20th Annual Health Law Institute March 6 and 7. The Institute provides attorneys with the opportunity to learn about the most recent statutory, regulatory, and case law developments in the health care industry. Co-sponsored by the Health Care Law Section of the State Bar of Michigan, this educational opportunity offers a range of presentations from numerous leaders in the health care legal community. Read More ›

Categories: Health Insurance Exchange, HIPAA, Medicare/Medicaid, Regulatory

Omnicare Settles Whistleblower Lawsuit Alleging Kickback Scheme With Nursing Homes

Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.

The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government. Read More ›

Categories: Billing/Payment, Fraud & Abuse, Medicare/Medicaid, Pharmacy, Providers

Michigan Senate Approves Medicaid Expansion

Michigan Senate ChamberThe Michigan Medicaid expansion saga has seemingly come to an end, as the Republican-led state Senate narrowly approved Medicaid expansion on Tuesday, August 27 in a 20-18 vote. Eight Republicans joined 12 Democrats to pass a bill that will bring billions of dollars in federal dollars to Michigan to implement a major element of the Patient Protection and Affordable Care Act. Under this bill, approximately 400,000 additional Michigan residents will be eligible for Medicaid coverage.

The vote came after lengthy debate in the Senate on the measure, and passed after "eleventh hour" legislative maneuvering. The Michigan House, which previously passed a Medicaid expansion bill, will likely approve the Senate version of the bill next week. If passed, it will be sent to Governor Snyder's desk for his signature.

Categories: Health Care Reform, Medicare/Medicaid, Providers

Michigan Senate Panel Moves Three Alternative Medicaid Bills Out of Committee

In early July, we updated our readers regarding the status of the Medicaid expansion debate in Michigan. At that time, a House-passed bill - supported by Governor Snyder - languished in a Senate committee because it was blocked by Senate Republicans who opposed the measure. Get an update ›

Categories: Health Care Reform, Medicare/Medicaid, Regulatory

Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud

medicare fraudSo far, July has been a busy month for health care fraud enforcement across the country.

On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›

Categories: Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians

Pioneer ACOs Find Blazing New Trails Isn't Always Easy

Covered wagonAccording to a recent Modern Healthcare article, up to 9 of the 32 Pioneer Accountable Care Organizations ("ACOs") may be leaving the program. Four have already notified providers of such withdrawal. Of the 9, 4 of the departing ACOs tentatively say they will be joining Medicare's lower- risk ACO alternative – the Medicare shared savings program. The deadline for deciding whether or not to remain in the Pioneer program is July 31, 2013. Read More ›

Categories: Accountable Care Organizations, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians

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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:

To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.