The Out-of-Network Consumer Protection Transparency Cost Containment and Accountability Act was adopted in June 2018 and went into effect last month.  It has gotten significant attention regarding emergent or urgent services rendered to patients, and the inability of out-of-network providers and facilities to balance bill the patient. » Read More

The Pennsylvania Commonwealth Court has upheld an order of the Department of Human Services (“DHS”) disallowing a nursing facility’s practice of billing Medicaid for Medicare cost-sharing amounts of dual eligible (Medicare and Medicaid) residents.  See Mulberry Square Elder Care v. D.H.S.» Read More

The Office of the Medicaid Inspector General (“OMIG”) has released its Work Plan for the next Fiscal Year, which encompasses April 1, 2018, through March 31, 2019.  The stated mission of the OMIG, an independent entity created within the New York State Department of Health, is to detect and prevent fraudulent practices within the Medicaid system and recover funds deemed improperly paid to health care providers. » Read More