Articles and Blogs


Michigan Medicaid Implements New Enrollment and Billing Requirements for Clinical Nurse Specialists and Nurse Practitioners


Posted on June 6, 2019 in Health Law News

Published by: Hall Render

On May 1, 2019, the Michigan Medical Service Administration of the Michigan Department of Health & Human Services (“MDHHS”) issued Bulletin MSA 19-10 (the “Bulletin”), which set forth new enrollment and billing requirements for nurse practitioners (“NPs”) and clinical nurse specialists (“CNSs”) participating in the Michigan Medicaid program. Under the new guidelines, effective June... READ MORE

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Hall Render’s This Week in Washington – April 12, 2019


Posted on April 12, 2019 in Federal Advocacy

Published by: Hall Render

Congressional Leaders Discuss Health Care Priorities Congress’ top leaders, Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Nancy Pelosi (D-CA), announced they are not embracing “Medicare for All” as a priority at the American Hospital Association’s annual Washington conference. Both leaders reinforced that each chamber will pursue largely separate health care agendas in... READ MORE

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Wisconsin Court Analyzes Relationship Between 340B and Wisconsin Medicaid Requirements in Important Overpayment Case


Posted on July 13, 2018 in Health Law News

Published by: Hall Render

On June 12, 2018, the Wisconsin Court of Appeals (“Court”) affirmed a decision by a Wisconsin circuit court and held that a family planning clinic with multiple locations in Wisconsin (“Provider”) was not required to repay the Wisconsin Department of Health Services (“DHS”) a total of $185,074.80 related to Medicaid fee-for-service claims submitted for... READ MORE

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Happy 50th Birthday Medicare and Medicaid: Midlife Crisis or the Golden Years?


Posted on July 30, 2015 in Health Law News

Published by: Hall Render

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


CMS proposes new “incident to” rule


Posted on July 10, 2015 in False Claims Act Defense

Written by: David B. Honig

“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

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Medicaid Managed Care Rule Overhaul: First Proposed Revisions in Over a Decade


Posted on June 5, 2015 in Health Law News

Published by: Hall Render

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

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Materiality and Government Knowledge in the Sixth Circuit


Posted on February 3, 2015 in False Claims Act Defense

Written by: David B. Honig

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

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Seventh Circuit Rejects Novel Fraud Theory


Posted on November 13, 2014 in False Claims Act Defense

Written by: David B. Honig

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

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Indiana Medicaid to Reimburse Home Health Agencies for Certain Telehealth Services


Posted on October 31, 2014 in Long-Term Care, Home Health & Hospice

Written by: Taylor, Allison L.

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

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Indiana Changing the Way Residents Will Obtain Medicaid Coverage Beginning June 1, 2014 – Part 4: Indiana Publishes Final Rule on Changes to Indiana’s Administrative Code


Posted on May 19, 2014 in Long-Term Care, Home Health & Hospice

Written by: Fahey, Sean J.

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

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