Out of the Mouths of Babes: Millions of Medicaid Dollars

Last Monday the Office of Inspector General of Health & Human Services posted a hair-raising report.  “Questionable Billing for Medicaid Pediatric Services in California” raises alarming questions about the billing practices and service quality of some of that state’s dentists—especially those working …

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House Bill Says 23 Years Isn’t Long Enough for Transition to ICD-10

All across the country hospitals have been bracing for the scheduled Oct. 1, 2015, transition from ICD-9 coding to ICD-10.  It had been scheduled for Oct. 1, 2014, but the Protecting Access to Medicare Act of 2014 delayed it until Oct. 1, 2015.  Before that it was scheduled for Oct. 1, 2013, but in 2012 the …

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New CMS Ruling on DSH Appeals for FY 2004 and Earlier

It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued Ruling No. CMS-1498-R2, addressing the nettlesome issue of how to treat certain …

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This Just in: OIG Rules Free Diapers Are Not an Illegal Kickback

  The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services.  In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider may give free diapers to Medicaid mothers without fear of federal …

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Annual Penny-Wise, Pound-Foolish Award Winner Announced

When it comes to the annual Penny-Wise, Pound-Foolish Award, don’t ever bet against the United States Congress.  This year, Congress lay back in the weeds until the year was almost over before making its move for the trophy.  But when it finally came, what a move it was! Under the Congressional spending …

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Seventh Circuit: No Fraud in Billing Medicaid More than Private Insurers for Drugs

Last Wednesday the Seventh Circuit affirmed the dismissal of a whistleblower suit brought by a pharmacist against his former employer, the Shopko pharmacy chain, for what he alleged was fraudulent billing of Medicaid by Shopko stores across the nation. Carl Thulin’s theory was imaginative—and complicated.  …

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