Tag Archives: Medicare

Nearly 1,400 understaffed nursing home recently saw their star rating lowered by Medicare

Understaffed nursing homes cause patients to be neglected. The most common result is the development of bed sores or broken bones after a fall, both leading to hospitalization. Until recently, the five star rating system published by the government  to … Continue reading

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New Update to the Medicare Program Integrity Manual Issued by CMS

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions … Continue reading

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Internal Medicine Physician Convicted in Los Angeles Federal Court After Six-Day Trial of Conspiracy to Pay or Receive Kickbacks for Medicare Referrals and Four Counts of Receiving Kickbacks.

Health care fraud and kickback cases can be difficult to defend due to the amount of documentation and when there are numerous cooperating witnesses. A recent case, seemed to have a number of weak, inconsistent witnesses who had already plead … Continue reading

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Medicare and Medicaid Providers: Choose Your Vendors Wisely—But Be Sure to Pay Them at Fair Market Value and for Bona Fide Services

Health care providers will often try to negotiate and receive fair, commercially reasonable business terms with vendors and suppliers, to both better serve their patients and improve their “bottom line.” Yet when it comes to services reimbursed by the government … Continue reading

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CMS Allows Step Therapy Under Medicare Advantage Plans

The Centers for Medicare and Medicaid Services (“CMS”) recently announced that, starting next year, Medicare Advantage (“MA”) plans will be allowed to require step therapy on Part B drugs and other physician-administered drugs. Step therapy requires patients to take generic … Continue reading

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