Tag Archives: Providers

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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New CMS payment system for skilled nursing facilities reimburses providers for care not volume

CMS new Patient-Driven Payment Model (PDPM) will be implemented on Oct. 1, 2019. CMS finalized the Patient-Driven Payment Model for skilled nursing facilities (SNF), which will link Medicare payments to value and care, rather than volume/ fee-for-service care. The rule according … Continue reading

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New on LLRX – Surveillance and Legal Research Providers: What You Need to Know

Via LLRX.com – Surveillance and Legal Research Providers: What You Need to Know – Legal research companies are selling surveillance data and services to law enforcement agencies including ICE. Their participation in government surveillance raises ethical questions about privacy, confidentiality … Continue reading

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Capitation Payments Aside, Transactions Between Government-Sponsored Managed Care Plans and Their Providers or Suppliers, Tainted by ‘Kickbacks,’ Are a Potential False Claims Act Violation, Says Court

Earlier this month, the federal District Court for the Northern District of Illinois, in U.S. ex rel. Derrick v. Roche Diagnostics Corp., sustained a whistleblower, or qui tam, complaint under the False Claims Act filed by a discharged employee of … Continue reading

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Nursing Providers – Designation of Disability Rights Texas as Protection and Advocacy System in Texas

Provider Letter – PL 18-08 (NF)  – Nursing providers have been issued a  new provider letter regarding Disability Rights Texas (DRTx). Prior to March 2011, Disability Rights Texas was known as Advocacy, Inc. As a part of recent rules amendments, HHSC Long-term … Continue reading

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