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Waste and Fraud

June 20, 2019 | Daily News

CMS on Thursday (June 20) released guidance that makes clear CMS’ expectations for how states should make sure they correctly determine Medicaid eligibility for the expansion population after lawmakers raised concerns following recent audits from the Office of Inspector General and others that found some states did not correctly determine eligibility.

June 19, 2019 | Daily News

The House late on Tuesday (June 18) passed legislation that would fund the Money Follows the Person demonstration through 2024, preserve asset protections for the spouses of Medicaid beneficiaries who receive long term care benefits and extend the Community Mental Health Services Demonstration.

June 13, 2019 | Daily News

CMS is auditing California, Kentucky and New York — and will soon begin an audit of Louisiana — following reports that those states incorrectly determined Medicaid eligibility for some beneficiaries who received coverage through the Affordable Care Act’s Medicaid expansion, CMS Administrator Seema Verma said in a letter to Senate Finance Committee leaders.

May 02, 2019 | Daily News

The Trump administration late Wednesday (May 1) told a federal appeals court it agrees with a district judge’s ruling that the entire health care law is invalid, yet also asked the court to retain certain ACA provisions the administration claims would not harm the plaintiffs, including updates to Medicare fraud laws – a move that left key legal experts scratching their heads.

April 12, 2019 | Daily News

Federal Medicaid advisers voted Thursday (April 11) to recommend that Congress eliminate the requirement for states to establish a Recovery Audit Contractor program.

March 25, 2019 | Daily News

The Office of Inspector General (OIG) is asking for $10 million in additional funding in fiscal 2020 to target fraud, waste and abuse in home and community-based settings, with a focus on four geographic hotspots that OIG associates with “suspicious behavior” -- Florida, Texas, and select areas in Southern California and the Midwest.

March 22, 2019 | Daily News

The HHS Office of Inspector General is asking for an additional $2 million in fiscal 2020 to beef up the state Medicaid Fraud Control Units, and on Thursday the OIG finalized a regulatory update to the program that was initially proposed in 2016.

March 08, 2019 | Daily News

Senate Finance Committee Chair Chuck Grassley (R-IA) and health subcommittee Chair Pat Toomey (R-PA) on Friday (March 8) lambasted CMA for failing to recoup improper Medicaid eligibility-related payments in excess of 3 percent made by states since 1992 and asked the agency to respond by March 15 on how they plan to fix the situation and whether they need Congress’ help to do so.

January 16, 2019 | Daily News

The White House Office of Budget and Management’s review of CMS’ tweaked home health pre-claims review demonstration, now called the Review Choice Demonstration for Home Health Services, has seemingly stalled since CMS submitted it to OMB for review, leaving Illinois providers preparing for a demonstration with an uncertain start date.

January 09, 2019 | Daily News

Senate Finance Committee Chair Chuck Grassley (R-IA) on Wednesday (Jan. 9) said he expects to spend time looking at Medicare and Medicaid waste, fraud and abuse now that he has resumed the chairmanship, along with health care anti-trust issues.

December 05, 2018 | Daily News

The White House Office of Management and Budget on Monday (Dec. 3) began reviewing a final rule aimed at improving the Medicare provider enrollment process in order to beef up program integrity.

November 26, 2018 | Daily News

CMS said the most recent improper pay rates show that, for the first time since the data has been reported, improper payment rates went down in Medicare fee-for-service, Medicare Advantage, Medicaid and the Children’s Health Insurance Program, and the fiscal 2018 Medicare fee-for-service improper pay rate is at the lowest since the 2010 rate.

November 01, 2018 | Daily News

The federal DC district court again ordered HHS to clear the backlog of Medicare appeals, saying that since the department told the court it could clear the backlog in fiscal 2022, the agency should do so by the end of that year and provide the court with updates on its progress.

October 25, 2018 | Daily News

Two California men have pleaded guilty to conspiring to defraud Affordable Care Act plans in at least 12 states by enrolling people in coverage and transporting them to expensive drug treatment facilities in California that paid referral and other fees, the Department of Justice announced.

September 10, 2018 | Daily News

A federal judge on Friday (Sept. 7) struck down a 2014 CMS rule that imposed a strict definition of Medicare Advantage overpayments and an exacting liability standard for when MA plans were required to report such overpayments and return them to CMS.

August 28, 2018 | Daily News

CMS is negotiating with inpatient rehabilitation facilities to potentially settle Medicare appeals, HHS says in a recent court briefing, and additional settlement meetings with the IRF lobby are expected in the upcoming months.

August 28, 2018 | Daily News

HHS projects that recent settlements and increased funding from Congress should allow the department to eliminate the Medicare appeals backlog in fiscal 2022 -- assuming the higher funding level for the Office of Medicare Hearings and Appeals continues -- so the district court shouldn't require anything but status reports from the department.

August 24, 2018 | Daily News

The HHS Office of Inspector General is asking for feedback on how to coordinate the anti-kickback and physician self-referral, or Stark, laws as well as how to set up safe harbors to help alternative pay models and the possibility of letting providers waive co-pays or provide other incentives to beneficiaries as a way to promote care engagement.

August 22, 2018 | Daily News

CMS will tweak a demonstration in order to continue allowing providers affected by state-wide moratoria on home health agencies and non-emergency ambulances to participate in Medicare, Medicaid and CHIP if there are proven access to care concerns, and the agency also will allow those that had a pending application denied when state-wide moratoria kicked in to participate in the programs through the demo.

August 14, 2018 | Daily News

Home health providers question how CMS' revamped home health demonstration will help stem fraud when the agency has recognized the high improper pay rate in that sector appears to be driven largely by paperwork problems, and suggest CMS look at alternatives.