Articles and Blogs

On July 30, 1965, President Lyndon B. Johnson signed into law what we now know as the Medicare and Medicaid programs.  They came into being after a long political gestation period that can be traced back to President Theodore Roosevelt’s proposals for a national health insurance system in 1912 and President Harry Truman’s 1948 bid... READ MORE

“Incident to” billing is a significant False Claims Act risk for Medicare and Medicaid providers. A new proposed rule will change how physicians and physician practices are supposed to bill for services provided in their offices. CMS Proposal to Limit Incident to Billing This week CMS released the proposed Medicare Physician Fee Schedule Rule... READ MORE

Health care providers and practitioners in most states are well aware that most Medicaid and CHIP enrollees are members of managed care organizations (“MCOs”). As states have increasingly contracted with and relied on MCOs for their growing Medicaid and CHIP populations, including enrollees who need and use long-term care services, the Centers for Medicare... READ MORE

Written by David B. Honig and Steven H. Pratt. On February 2, the Sixth Circuit Court of Appeals ruled on a case from the Southern District of Ohio, US ex rel American Systems Consulting, Inc. v Mantech Advanced Systems International. At issue was whether a court may determine whether a knowingly false statement in a proposal for... READ MORE

Relator Thulin was a pharmacist in Idaho working for Shopko, a Wisconsin company. He filed an FCA claim alleging Shopko defrauded Medicaid by failing to pass along private insurance plan prices to Medicaid for dual-eligible patients. The court rejected Shopko’s claim, affirming the trial court’s grant of a motion to dismiss. Dual-eligible Medicaid recipients... READ MORE

Senate Enrolled Act 554 from the 2013 legislative session set the stage for an upcoming change in Medicaid policy that will provide reimbursement for certain telehealth services provided by Home Health Agencies (“HHAs”).  The Indiana Health Coverage Programs (“IHCP”) released Bulletin BT201454 earlier this week outlining the policy change that will cover an HHA’s remote monitoring of data... READ MORE

On June 1, 2014, Indiana will change the way Indiana residents obtain Medicaid coverage in the age, blind or disabled categories. Currently, when Indiana residents apply for Medicaid coverage, they are subject to state-specific restrictive criteria. After June 1, 2014, Indiana residents will automatically be enrolled in Medicaid if the Federal Social Security Administration... READ MORE

On April 21, 2014, Indiana’s Family and Social Services Administration (“FSSA”) offered a webinar for nursing facilities to provide additional information on Indiana’s Medicaid changes and Qualified Income Trusts (also known as Miller Trusts). READ MORE

Indiana’s Family and Social Services Administration continues its efforts to communicate, address and refine questions and issues related to the upcoming Medicaid coverage changes.  READ MORE

President Obama introduced his fiscal year (“FY”) 2015 budget yesterday, and there are many proposed cuts to post-acute care providers.  Some of the highlights include a number of bundled payment initiatives, a $100 co-pay for home health patients not discharged from a hospital and re-admission penalties for skilled nursing facilities (“SNFs”) with high hospital... READ MORE