Tag Archives: Medicare

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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Medicare Secondary Payer Recovery Portal (MSPRP) Overview Webinar Slides Now Available

Last week, we posted about CMS’ overview webinar regarding the benefits of using the Medicare Secondary Payer Recovery Portal (MSPRP), a web-based application for managing Medicare recovery cases (or conditional payments).  The webinar slides from the webinar are now available … Continue reading

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Rehospitalization Rates for Medicare Patients Soars

According to a recent editorial in the NY Times, an alarming one-fifth of all Medicare patients discharged from the hospital end up back in the hospital within 30 days, and fully a third return within 90 days. If this yo-yoing could … Continue reading

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