Court Rules: Standard for Evaluating Reimbursement of Skilled Nursing Medicare Claims Was Material Improvement

CMS Releases Medicare Part B Supplier Billing and Payment Data

A False Claims Act (“FCA”) lawsuit in Georgia was dismissed on March 31, 2015, after a federal district judge ruled that the government’s expert witnesses used the wrong standard to determine whether certain skilled therapy services were reimbursable under Medicare Part A (United States ex rel. Lawson v. Aegis Therapies, Inc., S.D. Ga., No. 2:10-cv-00072-LGW-RSB, 3/31/15). The U.S. District Court for the Southern District of Georgia granted a rehabilitation therapy company and skilled nursing facility summary judgment on this basis. Continue reading this entry

CMS Proposes Expansion of Medicaid Mental Health Parity Requirements

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The Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule, on April 10, 2015, addressing the application of the Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) to the Medicaid and CHIP programs. The MHPAEA requires certain health insurance products, including coverage in the commercial group insurance market and ERISA plans, to offer any mental health and substance use disorder benefits covered by the plan at “parity” with medical or surgery benefits offered by the plan. Plans subject to the parity requirement may not impose financial requirements or treatment limitations on mental health or substance use disorder benefits that are more restrictive than comparable requirements that apply to medical or surgical benefits. CMS issued final regulations implementing the MHPAEA in 2013, but these regulations did not apply to governmental programs. Continue reading this entry

Does the "Doc Fix" Bill Help Telemedicine and Telehealth?

Telemedicine

In a word: yes.  Telemedicine was one of the many beneficiaries of changes introduced by the so-called “doc fix” bill, formally titled the Medicare Access and CHIP Reauthorization Act (H.R. 2). The legislation was passed by Congress on April 15, 2015 and signed into law by the President on April 16, 2015. It introduces sweeping changes to the reimbursement methodologies and financing of health care in the United States, including a notable shift away from the traditional fee-for-service model and towards accountable care organizations (ACOs), risk-based payment, and a focus on quality and population health.

As organizations embracing telemedicine recognize, these new payment models are ideally suited to the improved access, quality and care management offered by telemedicine technologies. The Act is a signal to the provider community that embracing innovative care delivery, such as telemedicine and telehealth, is an important step to positioning your organization to best capture these new payment opportunities. Continue reading this entry

Phishing and Spear Phishing: Modern Methods Applied to Age-Old Social Engineering

FoleyCybersecurityWP

It may surprise many who have observed the recent media attention of data breaches to learn that in the world of Cybersecurity, sometimes it’s the oldest attacks that find new life when they are applied in new ways. Phishing attacks, a form of social engineering where hackers try to trick their victims into revealing confidential information by impersonating as something legitimate, has been around for years. Fictional movies more than 20 years old depicted forms of phishing that are still in use today: The 1983 movie “Wargames” portrayed the fictional teenage hacker David Lightman deeply researching the original developer of the WOPR supercomputer to determine his back-door password “Joshua.” Today, the same type of spear phishing attacks used the movie, those that are directed towards a specific target through in-depth research of the individual’s background, are on the rise. While fortunately few attacks are likely to threaten a global thermonuclear war, it can be difficult to recover a company’s stability or an individual’s identity for victims of these attacks. Continue reading this entry

SEC Brings Enforcement Proceeding Relating to Confidentiality Agreements That May Stifle Whistleblowers

CMS Releases Medicare Part B Supplier Billing and Payment Data

After repeated public statements warning companies that might seek to stifle whistleblowers, the U.S. Securities and Exchange Commission (SEC) has brought its first enforcement action relating to language in confidentiality agreements that the SEC believes could impede whistleblowers from reporting potential violations of the securities laws. As discussed in more detail below, this action suggests that companies should re-examine their employment policies, severance agreements, codes of conduct, and any other practices utilizing language regarding confidentiality. Notably, the SEC views overly restrictive agreements as problematic, even without evidence that any whistleblower actually has been deterred from whistleblowing activity.
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