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Medicaid

Jun 25, 2019

Whistleblower Complaints Resulting in Increased MFCU Investigations

Considering the significant financial incentives and awards provided to whistleblowers, it should come as no surprise that there has been a marked increase in the number of health care fraud investigations commenced by federal and state agencies.  The New York State Medicaid Fraud Control Unit (“MFCU”) is one such agency and is increasingly worthy of the attention of health care practitioners who treat Medicaid patients in the state. » Read More

Sep 18, 2018

Billing Pennsylvania Medicaid for Nursing Facility Residents’ Medicare Part B Copays Ruled as Impermissible Balance Billing

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

Apr 25, 2018

New York State – OMIG Releases its Work Plan for the 2018/2019 Fiscal Year

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

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