Category Archives: Medicaid

eClinicalWorks Case Raises New Questions

On May 31, 2017, the U. S. Department of Justice (DOJ) announced that eClinicalWorks (ECW) agreed to pay a $155 million settlement and enter a corporate integrity agreement with the OIG to resolve allegations that ECW caused its health care provider customers to submit false Medicare and Medicaid claims for meaningful use payments in violation of the False Claims Act (FCA). Under the corporate integrity agreement, ECW agreed to strict compliance and reporting obligations and to provide the latest version of ECW’s EHR software to each of ECW’s current customers free of charge. Continue reading

OIG Corporate Integrity Agreements and Physician Compliance Programs

In settling allegations of violating the False Claims Act (FCA), healthcare providers often enter into a Corporate Integrity Agreement with the OIG in exchange for the OIG’s agreement not to exclude the provider from participation in Medicare or other federal health care programs. Corporate Integrity Agreements (CIAs) generally require a provider to establish or supplement an existing compliance program, with detailed requirements described in the CIA. Continue reading

Enrollment Begins for Louisiana’s Medicaid Expansion

Beginning June 1, 2016, Louisiana residents with a household income below 138 percent of the federal poverty level will be eligible to obtain healthcare coverage through the state’s Medicaid program. On January 12, 2016, Gov. John Bel Edwards signed an executive order to expand the Medicaid program, making Louisiana the 31st state to extend Medicaid.

The U.S. Department of Health & Human Services also approved a new approach to Medicaid enrollment that will allow Louisiana to use information from the Supplemental Nutrition Assistance Program (SNAP) to determine eligibility and enroll individuals in Medicaid.  Louisiana is the first state to be approved to use this enrollment strategy through the use of a state plan amendment.

Quick Facts:

  • Enrollment began on June 1
  • Coverage will be effective July 1
  • The State of Louisiana estimates that 375,000 new adults will enroll in coverage, with about 105,000 people already enrolled in SNAP identified as likely eligible for coverage.
  • Through 2016, the coverage for newly enrolled adults of up to 138% of the federal poverty line is completely funded with federal money. However, federal funding rates will decline beginning in 2017 (Federal funding rates will not fall below 90% of costs). [1]


[1] U.S. Department of Health & Human Services, HHS Secretary Sylvia M. Burwell Applauds Louisiana Medicaid Expansion Under the Affordable Care Act, (May 31, 2016).

Written by: Catherine Moore

Moore, Catherine headshot

OIG Making Widespread Review of Questionable Billing Practices for Pediatric Dental Services – Louisiana Included

The Office of Inspector General of the United States Department of Health and Human Services is reviewing questionable billing practices related to Medicaid billing for pediatric dental services throughout Louisiana. A description of this state and national initiative can be found here. Continue reading

New York Whistleblower Court First to Address What It Means to “Identify” Overpayment under ACA’s 60 Day Rule

For the first time since its enactment as part of the Affordable Care Act (ACA) in 2010, a federal court in a whistleblower action will consider a provision requiring providers to return overpayments within sixty days of when they are “identified.”  The upcoming decision by the United States District Court for the Southern District of New York in U.S. ex rel. Kane v. HealthFirst Inc. et al  will likely be just  the first of many decisions on the subject.   Providers and government regulators are poised for what could prove a lengthy dispute at both the trial and appellate levels around the ACA’s 60 day rule and its interplay with overpayments in the False Claims Act (FCA) context. Continue reading

ICD-10 Delay Update

The house bill (HR 4302) delaying implementation of ICD-10 moved quickly through the Senate on Monday and was signed by President Obama on Tuesday. The ICD-10 delay, which was included in a much broader bill to delay Medicare payment cuts to doctors, prohibits the Centers for Medicare and Medicaid Services (CMS) from enforcing any mandate to switch from ICD-9 to ICD-10 until at least October 1, 2015. Since the language focuses on preventing CMS from enforcing a mandate, several questions remain including whether October 1, 2015 is the new deadline for implementation.

Written by: Traci Thompson

 

The New Two-Midnight Rule – Scrutiny Delayed for 90 Days

The Center for Medicare and Medicaid Services (CMS) released what has become known as the “Two Midnight Rule” on August 2, 2013 in the Inpatient Prospective Payment System (IPPS). The Final Rule is available in the August 19, 2013 Federal Register.
Last week, in response to provider concerns and a letter from more than 100 members of Congress asking for postponement of the rule, CMS announced a 90 day implementation period beginning on October 1, 2013. Continue reading