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Medicaid › Penalties

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Holland & Hart LLP

FMV for Provider Contracts: Regulatory Standards

Holland & Hart LLP on

As a general rule, healthcare employers are required to pay employed physicians and other contracted providers fair market value (FMV) for their services, but many employers do not understand relevant regulatory standards. ...more

Mandelbaum Barrett PC

Medicaid Final Agency Decision Reaffirms Criteria Necessary to Qualify for Caregiver Child Exception

Mandelbaum Barrett PC on

Certain Medicaid programs impose a transfer penalty on applicants who have transferred resources (assets) for less than fair market value within five (5) years preceding the Medicaid application. Simply stated, the transfer...more

ArentFox Schiff

Investigations Newsletter: Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme

ArentFox Schiff on

Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme - The Chicago-based owner of two laboratories, Zoom Labs Inc. and Western Labs Co., has been charged with health care fraud...more

Mandelbaum Barrett PC

Medicaid Alert: Changes to Medicaid’s Penalty Divisor Effective April 1, 2024

Mandelbaum Barrett PC on

Beginning April 1, 2024, the State of New Jersey will increase the Medicaid penalty divisor to $440.10 per day, as compared to the previous penalty divisor of $384.57 in 2023. See Medicaid Communication No. 24-03....more

Lippes Mathias LLP

New York State Medicaid Updates for 2024

Lippes Mathias LLP on

Medicaid is a joint federal and state program that provides health coverage to millions of Americans. Federal law requires states to comply with certain minimum requirements, but New York is considered a maximum state in that...more

Harris Beach PLLC

New York Medicaid Inspector General’s Office Posts Compliance Program FAQS

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On September 21, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) posted on its website Compliance Program Requirements Frequently Asked Questions. OMIG intends the FAQs to supplement its Compliance...more

King & Spalding

CMS Announces Increased Scrutiny for Poor-Performing Nursing Facilities

King & Spalding on

On October 21, 2022, CMS announced new actions to increase accountability and scrutiny on nursing homes in the Special Focus Facilities Program (SFF Program), an oversight program for the poorest performing nursing homes in...more

Mintz - Health Care Viewpoints

With Proposal to Cap Drug Price Increases, Massachusetts Once Again Takes Center Stage in the Drug Pricing Debate

Mintz - Health Care Viewpoints on

On March 17, the same day we wrote about proposed legislation in Connecticut to cap drug price increases, Governor Charlie Baker of Massachusetts included a similar proposal in his proposed budget. Similar to the Connecticut...more

Flaster Greenberg PC

Medicaid Caregiver Child Exemption Success Story in New Jersey: Home Saved & Nursing Home Paid

Flaster Greenberg PC on

Flaster Greenberg’s seasoned elder law attorney, Jane M. Fearn-Zimmer, obtained a landmark Medicaid Final Agency Decision for her elderly, ailing client and her family after a three-year long dispute with the New Jersey...more

Dorsey & Whitney LLP

Significant Changes in Healthcare Laws Enacted Through the Bipartisan Budget Act of 2018: Stark, Civil and Criminal Penalties,...

Dorsey & Whitney LLP on

On February 9, President Trump signed the Bipartisan Budget Act of 2018 (“BBA”) into law. The BBA funds the federal government through March 23 and included a bipartisan agreement to increase annual spending authority for a...more

Foley & Lardner LLP

Senate Releases Repeal and Replace Legislation on ACA: The Better Care Reconciliation Act of 2017

Foley & Lardner LLP on

After weeks of secrecy, the Senate has released a discussion draft of legislation that is the counterpart of the American Health Care Act (AHCA) previously passed by the House. The Senate legislation, entitled the Better Care...more

Bass, Berry & Sims PLC

The Better Care Reconciliation Act: Similarities to House Health Care Bill, Preserves Parts of ACA

Bass, Berry & Sims PLC on

On June 22, 2017, Senate Republicans released a draft of the Better Care Reconciliation Act (BCRA), their much-anticipated version of the legislation to "repeal and replace" the Affordable Care Act (ACA). Despite rumors of a...more

Bass, Berry & Sims PLC

Key Provisions of the American Health Care Act

Bass, Berry & Sims PLC on

On March 6, 2017, Republicans in the House of Representatives unveiled two bills that aim to repeal and replace the 2010 Patient Protection and Affordable Care Act (ACA). The bills, collectively called the American Health...more

Carlton Fields

MACRA: Top 10 FAQs

Carlton Fields on

Significant changes to the Medicare payment system are underway. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is set to take effect January 1, 2017. MACRA represents a deliberate departure by the...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: Monthly Expansion Recap - September 2016

Manatt, Phelps & Phillips, LLP on

National News - Growth in Prescription Drug Spending Not Linked to Medicaid Expansion, Study Finds - Medicaid expansion was not likely a “major driving force” behind the record high drug spending growth in 2014,...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - September 2016 #2

Manatt, Phelps & Phillips, LLP on

CMS denies Ohio’s Medicaid 1115 waiver request citing the State’s premium proposal; HHS will use 2015 risk corridors collections for remaining 2014 payments; and Alabama closes its Medicaid budget shortfall....more

Sherman & Howard L.L.C.

The Department of Justice Ups the Ante: Per Claim Penalties for False Claims Act and Anti-Kickback Statute Violations Nearly...

Sherman & Howard L.L.C. on

On June 30, 2016, the Department of Justice (“DOJ”) published an interim file rule that dramatically increases the per claim penalties for violations of the False Claims Act (“FCA”) and the Anti-Kickback Statute (“AKS”) among...more

Chambliss, Bahner & Stophel, P.C.

The Hardship Exception to the Medicaid Penalty Period: Rare But Possible

Chambliss, Bahner & Stophel, P.C. on

If you transfer assets within five years of applying for Medicaid, you will likely be subject to a period of ineligibility. There is an exception, however, if enforcing the penalty period would cause the applicant an "undue...more

King & Spalding

November and December 2015 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

King & Spalding on

Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties. To avoid such...more

King & Spalding

CMS Proposes Sweeping Changes to Medicare Reimbursement for Clinical Diagnostic Laboratory Tests

King & Spalding on

First Data Collection Period for Clinical Laboratories Is July 1, 2015 to December 31, 2015 - In the October 1, 2015 Federal Register, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule...more

Manatt, Phelps & Phillips, LLP

Corporate Investigations & White Collar Defense - October 2015

Manatt, Phelps & Phillips, LLP on

"Wherefore Art Thou Due Process?" Part III - Why it matters: It is time for another installment in our continuing "Wherefore Art Thou Due Process?" coverage into the ongoing constitutional challenges to the SEC's...more

Dickinson Wright

New CMS Proposed Rule Provides Who/What/When for Clinical Laboratory Reporting Requirements Starting January 1, 2016

Dickinson Wright on

Clinical laboratories will see significant changes to their Medicare payments for clinical diagnostic laboratory tests (CDLTs) starting January 1, 2017, but the basis for new payment rates will come from “applicable data”...more

Manatt, Phelps & Phillips, LLP

Health Update - September 2015

Manatt, Phelps & Phillips, LLP on

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - August 2015

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Editor's Overview - As the summer draws to a close, this month's Newsletter previews three cases that the U.S. Supreme Court already has agreed to hear that ought to be of particular interest to ERISA plan sponsors and...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - June 2015 #3

Manatt, Phelps & Phillips, LLP on

With the King v. Burwell ruling expected by the end of the month, Congressional Republicans continue to offer contingency plans in the event of a ruling for the plaintiffs; and the Mississippi Insurance Commissioner proposes...more

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