LexisNexis® Legal Newsroom
Norton Rose Fulbright: OIG Releases FY 2014Work Plan Summary

By Frederick Robinson , Megan Fanale Engel , Cori Annapolen Goldberg and Selina Coleman On January 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published its Work Plan for fiscal year 2014. The OIG announced that in the upcoming year, it will continue...

Williams Mullen: OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare

By Marcus C. Hewitt H.H.S’s Office of Inspector General’s yearly work plan was issued on January 31, 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review Medicare payments to hospitals for outpatient evaluation...

Barnes & Thornburg LLP: OIG Work Plan 2014: Takeaways for Hospitals

By Gayland Hethcoat With the release of its work plan for fiscal year 2014 on Jan. 31, 2013, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has provided insight on the agency’s current enforcement priorities in Medicare, Medicaid, and other HHS programs...

Norton Rose Fulbright: CMS Offers New Resources and Guidance on 2-Phase Approach to Sunshine Act Reporting

By: Benjamin Koplin , Selina Coleman and R. Jeffrey Layne The Centers for Medicare & Medicaid Services (CMS) has posted new resources to its "Open Payments" website to clarify its recently announced two-stage approach to registration and data submission. These resources include: ...

State Net Capitol Journal – March 10, 2014; 2013 (Sort Of) 'Year Of Tax Reform'

Budget & Taxes 2013 (SORT OF) 'YEAR OF TAX REFORM': Early last year many predicted 2013 would be "the year of tax reform" in the states, due to the unusually high number of tax measures that had been proposed, a number of which included major reforms. But according to the results...

State Net Capitol Journal – May 19, 2014; States Souring On Property Taxes

Budget & Taxes STATES SOURING ON PROPERTY TAXES: Not for the first time, Pennsylvania Sen. David Argall (R) is backing a bill that would replace property taxes levied by school districts with higher state income and sales taxes. But this year, more than half of the state's senators are co...

Steptoe & Johnson PLLC: False Billing Leads To Record Settlement In Medicare/Medicaid Fraud Case

The United States Attorney for the Southern District of West Virginia has announced a record $4.675 million settlement with a medical lab for false billings to Medicare and to West Virginia Medicaid. R. Booth Goodwin, of Charleston, WV, said in his press release that Calloway Laboratories of Woburn,...

Foley & Lardner LLP: 8th Circuit Dismisses Whistleblower's Suit Finding Facts Were Already Publicly Disclosed

By Jacqueline N. Acosta In an August 7, 2014 opinion, the Eighth Circuit upheld the dismissal of a whistleblower’s suit alleging that a number of pain pump device makers had violated the False Claims Act (FCA) by marketing their pain pumps for harmful off-label uses. United States ex rel. Paulos...

Norton Rose Fulbright: Physicians Payments Sunshine Act Data 33 Percent Unpublishable, Penalties Next?

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician Payments Sunshine Act website is still expected...

Study Finds States With Expanded Medicaid Experiencing Bump In ER Volume

GREENWOOD VILLAGE, Colo. — (Mealey’s) States with expanded Medicaid under the Patient Protection and Affordable Care Act (ACA) saw a threefold increase in emergency-department visits over nonexpansion states in the second quarter of 2014, according to a Sept. 8 study. (This story is an...

State Net Capitol Journal – September 29, 2014; States Taxing Tourists

Budget & Taxes STATES TAXING TOURISTS: State and local governments across the country are increasingly looking at charging seasonal residents higher property taxes than year-round residents for the privilege of enjoying their locales' scenic beauty and mild winter weather. "Hit the...

State Net Capitol Journal – January 19, 2015; Supreme Court To Decide Fate Of Colorado Taxpayer's Bill of Rights

Budget & Taxes SUPREME COURT TO DECIDE FATE OF CO TABOR: Colorado's Taxpayer's Bill of Rights — requiring lawmakers to obtain voter approval to raise taxes and to issue refunds to taxpayers when revenues grow faster than inflation and population growth — has survived repeated...

Workers’ Compensation and Its Secondary Payers: Medicare and Medicaid

Last November I had the pleasure of participating in a panel with two more eminently qualified folks—Jennifer C. Jordan of MEDVAL, LLC and Tim Nay at Nay & Friedenberg —about Medicare Secondary Payer (MSP) compliance at the 23rd Annual National Workers’ Compensation and Disability...

Ask Liza: Do I Need a Special Needs Trust for a Son on SSDI?

Dear Liza: I have an adult son who is developmentally disabled. He is able to work and receives Social Security Disability Insurance as well as Medicare. Does he need a Special Needs Trust? I love it when someone asks me a question with a clear answer! Here, the answer is probably not. Your son receives...

Worksite Wellness Clinics and Reduction of ER Visits: Good News for Employer Health Plan Costs

By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations Emergency room visits and costs are on the rise in the U.S. and expected to get worse with Obamacare according to a recent report which shows people with Medicaid (many of whom have obtained coverage under Obamacare) use ER...

Court Holds that ‘Supremacy Clause’ Does Not Create a Private Right of Action to Enforce the Provisions of Medicaid

On Tuesday, March 31, 2015, in Armstrong v. Exceptional Child Center, Inc. , No. 14-15 (U.S. March 31, 2015), [ enhanced version available to lexis.com subscribers ], the Supreme Court ruled 5-4 that private parties do not have the right under the U.S. Constitution’s Supremacy Clause, [ enhanced...

Supreme Court Holds Providers Cannot Sue States to Challenge Low Medicaid Rates

The Supreme Court ruled, on March 31, in a 5-4 decision, [ enhanced version available to lexis.com subscribers ], that hospitals and all other providers cannot sue to force a state to pay higher Medicaid rates. The name of the case is Armstrong v. Exception Child Center. In Armstrong , the plaintiffs...

DLA Piper Health Systems Alert: MACRA: 3 Compliance Implications For Medicare Providers

By: Karen Nelson Much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its repeal of the Sustainable Growth Rate formula for physician compensation and the potential gainsharing safe harbor. But the Act also includes certain Medicare program integrity provisions...

Foley & Lardner LLP: The Medicaid Fraud Control Units: Fiscal Year 2014 Report

By Judith A. Waltz The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs) (OEI-06-15-00010, April 2015). Although the MFCUs reported another...

Foley & Lardner LLP: CMS Proposes Major Update to Medicaid Managed Care Regulations

By Anil Shankar and Adam J. Hepworth The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“ Proposed Rule ”). The number of individuals enrolled in Medicaid managed care...

Foley & Lardner LLP: CMS Proposes Major Update to Medicaid Managed Care Regulations

By Anil Shankar and Adam J. Hepworth The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“ Proposed Rule ”). The number of individuals enrolled in Medicaid managed care...

Top Court Rejects Maine’s Challenge To ACA ‘Maintenance Of Effort’ Rule

WASHINGTON, D.C. — (Mealey’s) The Supreme Court on June 8 denied the State of Maine’s petition challenging mandatory continued Medicaid coverage for older children under the Patient Protection and Affordable Care Act’s maintenance of effort requirements, according to the docket...

State Net Capitol Journal – June 15, 2015; California Considering Prop 13 Reform

Budget & Taxes CA Considering Prop 13 Reform A bill introduced last week in California would overhaul Proposition 13 -- the landmark property tax limit initiative approved by the state’s voters in 1978 -- to allow regular reassessments of commercial and industrial properties. Currently...

Cadwalader: Federal Court Upholds Provider Mandate to Report and Return Medicare and Medicaid Overpayments in 60 Days

Introduction | The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed care organizations that were overpaid...

State Net Capitol Journal – August 17, 2015; States Back Tax Breaks for Military Vets

Budget & Taxes States Back Tax Breaks for Military Vets Despite facing a budget shortfall this year, Maryland doubled its income tax exemption for military retirement pay to $10,000. And a budget hole forced Connecticut to raise taxes on its most prosperous corporations, but it still managed...