Pennsylvania legislators have announced their intention to introduce a series of anti-fraud measures this session, which includes a new state false claims act. Citing the impact of the federal False Claims Act, the proposal represents a bi-partisan effort to curb fraud, waste, and abuse in Commonwealth programs, including Medicaid.» Read More

As this blog previously addressed, the price disclosure requirement issued by the Department of Health and Human Services emanated from the Affordable Care Act and requires hospitals to post price information on the internet in a machine-readable format. Starting on January 1, 2019 this became an affirmative obligation for hospitals.» Read More

Starting January 1, 2019, hospitals have been reporting their standard charges online in an easily accessible format, due to a new rule from the Centers for Medicare and Medicaid Services (CMS).

With the passage of the Affordable Care Act, hospitals were required to release a list of prices for their items and services to the public; however, the initial rulemaking required that either the charges themselves be made public, or the hospital’s policy for allowing public review of the hospital’s charges upon request be made public. » Read More

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 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

The Centers for Medicare and Medicaid Services (“CMS”) Administrator Seema Verma on January 18, 2018, identified as agency priorities the modernization of the Stark Statute to reflect the move from a fee-for-service to a value and outcomes based payment under Medicare and the review of barriers created by the Stark Statute. » Read More