Stark Realities: How the Physician Self-Referral Act Affects Group Practices
Dingeman, Dancer & Christopherson, P.L.C.
Though the Physician Self-Referral Act (Often called the Stark Law or Stark II) was enacted in 1993, few Physicians.
Provider-Based Entities
Jodi B. Laurence of Broad and Cassel
The Health Care Financing Administration ("HCFA") recently clarified its policy regarding provider-based designatio.
Florida Medicaid Eligibility Requirements
Michael W. Porter of Michael W. Porter, P.A.
Medicaid is a federal and state program designed to supplement the income of persons who require medical and/or nur.
Operational Policy Letter: Transition from 1876 Risk Members to Medicare+Choice Plans
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services which provides guidance regarding the transition to Medicare+Choice plans.
Special Needs Trusts: A Planning Tool with Promise
Ruthann P. Lacey, P.C.
As advances in medical technology are made available to the average American, and as public benefit eligibility law.
The Administration's Response to Questions about the State Children's Health Insurance Program--Fourth Set
Dept. of Health and Human Services
Publication from the Department of Health and Human Services which answers various questions raised by states, providers, consumers and others about the State Children's Health Insurance Program.
The Link Between Medicaid and Social Security Coverage of Children Under Welfare Reform
Dept. of Health and Human Services
Fact sheet prepared by the Department of Health and Human Services regarding the link between Medicaid and the new definition of disability for children under welfare reform.
Social Security: Working While Disabled, How We Can Help
Social Security Administration
This publication explains the Social Security Administration work incentives.
The Many Faces of Health Care Fraud
Cadwalader, Wickersham & Taft LLP
In previous columns, we have explored the federal government's increasingly aggressive war on health care fraud and.
Arent Fox Alerts
Allison Weber Shuren of Arent Fox LLP
This article reviews some of the key provisions of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999.
Program of All-Inclusive Care for the Elderly (PACE) History
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which describes the history of the All-Inclusive Care for the Elderly program under Medicare and Medicaid.
OIG Publishes Final Rule Concerning Exclusion of Indirect Provides
Broad and Cassel
Recently, the Office of Inspector General of the Department of Health and Human Services (the "OIG") published its .
Social Security Benefits in Nebraska: Help from Three Agencies
Broom, Johnson Law Firm
When people cannot work, have no long term disability coverage, and their health insurance has run out, they will .
Protecting Nursing Home Residents from Eviction
Diviacchi Law Office
The costs of nursing home care for the elderly are such that over one-half of all nursing home residents at some p.
HHS Audit and Investigation Priorities in 1999
Scott D. Godshall of Pepper Hamilton LLP
This article examines the HHS's focus on compliance programs and qui tam litigation in 1999.
Nursing Homes May Challenge Medicare and Medicaid Regulations
Tydings & Rosenberg LLP
A federal appellate recently ruled that nursing homes have standing to challenge Medicare and Medicaid regulations .
Common Questions
McMahon Law Firm, Attorney and Counselor at Law
If I transferred money to my children now would I have to wait thirty-six months before I could be eligible for Medicaid?
Provider-Based Status: Proposed Rules Require Advance Determination
Patricia Owen Powers of Waller Lansden Dortch & Davis LLP
The Health Care Financing Administration (HCFA) proposed rules on Sept. 8 for the payment of hospital outpatient se.
Government Programs or Private Resources: Alternatives for Paying for Long Term Health Care
Ruthann P. Lacey, P.C.
Due to continued improvements in lifestyle and medical technology, it comes as no surprise that as the first Baby B.
Changes in Physician Incentive Plan Regulations
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services to Medicare Managed Care Organizations State Medicaid Agencies which outlines changes made in the regulations regarding physician incentive plans.
Prospective Payment System Final Rule For Hospital Outpatient Services Released-April 2000
Saul Ewing LLP
The Health Care Financing Administration ("HCFA") published its final regulation regarding the outpatient prospecti.
Summary Provision
Broad and Cassel
The Stark law was unclear with regard to its application to Medicaid services. Because only services reimbursed by.
Elder Law: Disability & Asset Protection Planning
Rob Goldman of Rob Goldman Legal Solutions A Professional Law Firm
This article discusses the essential basic estate planning considerations and documents every senior citizen ought .
Problematic Gifting
Jason A. Penrod of Weaver, McClendon & Penrod, LLP
There are many misguided beliefs about reducing assets to qualify for Medicaid long-term care benefits. In fact, one of the most commonly mistaken beliefs is that a Medicaid applicant or potential applicant can simply gift or transfer assets to another person or into another person's name in order to qualify for Medicaid benefits. As this article explains, the gifting of assets can disqualify an individual from receiving benefits to pay for nursing home care for a significant period of time.
Update: Corrections To Proposed Privacy Rule
Mark Tatelbaum and Robert Waters of Arent Fox LLP
This article contains corrections to the Department of Health and Human Services proposed rule for Standards for Privacy of Individually Identifiable Health Information.
OIG Challenges Hospital Ãâ Physician "Gainsharing" Arrangements What Is Left For Hospitals?
Gregory R. Watchman and John Oakes of Paul, Hastings, Janofsky & Walker LLP
This Client Alert considers the implications of the Summary of the Office of the Inspector General (OIG) Bulletin regarding Gainsharing agreements.
Health Law Highlights Issue
James Fabian,Stephen D. Zubiago and Richard T. Yarmel of Nixon Peabody LLP
The Office of the Inspector General (OIG) issued a Special Fraud Alert in which the OIG puts health care providers and physicians involved in rental arrangements for space in physicians? offices on notice that they can expect increased scrutiny in this area.
Georgia Medicaid Law--1999
Ruthann P. Lacey, P.C.
The costs of long term health care can be staggering. For many people, being prepared to meet them can be an even .
Operational Policy Letter: Transition from 1876 Risk to Medicare+Choice Enrollment and Disenrollment Policies
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services which provides answers to questions regarding the transition from ?1876 risk to Medicare+Choice enrollment and dis-enrollment policies.
Your Rights Under the Community Service Assurance of the Hill-Burton Act
Dept. of Health and Human Services
Fact sheet from the Department of Health and Human Services which describes individuals' rights and responsibilities under the Community Service Assurance provisions of the Hill-Burton Act, which are formally known as Titles VI and XVI of the Public Health Service (PHS) Act.
The 2003 Medicare Prescription Drug, "Improvement" And Modernization Act Provides Increased Revenue Opportunities
Susan L. Fine and Lisa Rediger Hayward of Davis Wright Tremaine LLP
Signed into law on Dec. 8, 2003, the Medicare Prescription Drug, Improvement and Modernization Act, P.L. 108-173 (the "Act"), with close to 200 major sections, has been called the largest overhaul to the Medicare Program since its inception. The Act not only creates a historic prescription drug benefit, but makes significant payment changes to Medicare Part A and Part B, and Medicaid. Congress has hailed the Act as correcting existing payment "inequities."
Beware Of Parents Bearing Gifts
Scheier & Katin, P.C.
Under present law, people who gift their property in order to qualify for Medicaid Benefits could be subject to a .
Social Security Benefits for People Living With HIV/AIDS
Social Security Administration
This publication explains how people with HIV/AIDS may qualify for disability benefits from the Social Security Administration under two programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Department of Health and Human Services Advisory Opinion: Discounted Ambulance Services
Dept. of Health and Human Services
Advisory letter from the Department of Health and Human Services which discusses certain arrangements for discounted ambulance services provided to residents of Medicare skilled nursing facilities under the anti-kickback statute, section 1128B(b) of the Social Security Act.
Medicare Definition of Fraud
Dept. of Health and Human Services
Brochure produced by the Department of Health and Human Services which describes the definitions of fraud under Medicare in connection with entitlement or payment under the Medicare program.
Program of All-Inclusive Care for the Elderly: Questions and Answers
Dept. of Health and Human Services
Brochure from the Department of Health and Human services providing answers to questions regarding the program of all-inclusive care for the elderly.
Long Term Care of Elderly: The Qualified Income Trust
Andrew J. Potts of Baker, Donelson, Bearman, Caldwell & Berkowitz, PC
Many people face a financial challenge when a relative must receive long term care in a nursing home.
Home Health Agencies Learn That Nothing is Constant But Change
Dykema Gossett PLLC
The year 1997 has been a busy regulatory year for home health agencies ("HHAs") that transact business .
The Administration's Response to Questions about the State Children's Health Insurance Program--First Set
Dept. of Health and Human Services
Publication from the Department of Health and Human Services which answers various questions raised by states, providers, consumers and others about the State Children's Health Insurance Program.
HCFA clarifies -- somewhat -- self-referrals The (Charlotte) Business Journal
Joel M. Leander of Womble Carlyle Sandridge & Rice, PLLC
New proposed regulations recently published by the Health Care Financing Administration, the federal agency respons.
Top Twenty Medicare/Medicaid Questions
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which answers for consumers the top twenty 20 questions most frequently asked by callers to the Medicare + Choice toll free line.
Health Care Financing Administration Issues Payment Suspension Rules
Lester J. Perling of Broad and Cassel
The Health Care Financing Administration ("HCFA") recently issued final rules, effective January 2, 1997, governing.
Medicare Has More To Offer
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which generally describes new benefits to consumers under Medicare.
Public Assistance Guide
DHS - Federal Emergency Management Agency
Guide from the Federal Emergency Management Agency designed to help government officials apply for, obtain and use Federal assistance.
Stark II: What it Means for Group Income Distribution Plans
Deborah W. Larios of Waller Lansden Dortch & Davis LLP
For many medical groups, revenues from ancillary services make up a substantial portion of the group's profits. Inc.
Latest Advisory Opinion Questions Percentage Fee Arrangement with Physician Practice Management Company
David H. Eisenstat,David B. Palmer,Jorge Lopez and Eugene E. Elder of Akin Gump Strauss Hauer & Feld LLP
This article discuses the Office of the Inspector General's Advisory Opinion No. 98-4 which is considered significant because it suggests that a physician who pays a practice management company a percentage of the physician's net revenues may violate the federal Anti-Kickback Statute when the services provided by the practice management company include marketing and billing activities.
Underuse Regulation of Physician Incentive Plans
Howard M Robinson of Broad and Cassel
For years, the Federal anti-kickback and self-referral laws have been the primary vehicles for health care fraud en.
Fact Sheet on the Children's Health Insurance Program and Child Support Enforcement
Dept. of Health and Human Services
Summary from the Department of Health and Human Services (DHHS) which outlines DHHS's the Children's Health Insurance Program and Child Support Enforcement policy under Medicaid.
The Administration's Response to Questions about the State Children's Health Insurance Program--Third Set
Dept. of Health and Human Services
Publication from the Department of Health and Human Services which answers various questions raised by states, providers, consumers and others about the State Children's Health Insurance Program.
Limitations on Medicaid Liens in Personal Injury Recoveries
Douglas G. Schaller of Johnson, Clifton, Larson & Schaller, P.C.
As with other Medicaid payors, the Oregon Department of Human Services (ODHS) is compelled by state law to seek reimbursement out of personal injury recoveries for paid Medicaid benefits. The lien rights of such state agencies are not without limitation, however, and those limitations can make a huge difference for clients when their damages exceed the available liability coverage.
Guidance for States Considering the Development of Medicaid Managed Care Programs for Persons With Special Health Care Needs
Dept. of Health and Human Services
Guide prepared by the Department of Health and Human Services for states considering the development of Medicaid managed care programs for persons with special health care needs.
OIG Sets Provider Self-Disclosure Protocol
Michelle Bellamy Marsh of Waller Lansden Dortch & Davis LLP
What do you do if, during your compliance activities, you discover an overpaymen.
Private Contracts with Practitioners Who Do Not Provide Services Through the Medicare Program
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which describes Medicare payments to medical practitioners under private contract in the Medicare program.
Sanction Authorities and Their Application to Parent, Subsidiary and Brother and Sister Organizations
Gabriel L. Imperato of Broad and Cassel
The United States Congress has consistently expanded the administrative sanction authority of the Office of Inspect.
PhRMA v. Walsh: The Supreme Court's First Word in the Latest Conflict Between States and Drug Companies Over the Price of Prescriptions
Michael J. Yanochik of Beirne, Maynard & Parsons, L.L.P.
In May 2003, the United States Supreme Court rendered a decision of significant interest to pharmaceutical manufacturers in Pharmaceutical Research & Mfrs. of Am. v. Walsh, 538 U.S. 644, 123 S.Ct. 1855 (2003). Although the full impact of the Walsh decision will not be known until the case is decided on the merits ? the Supreme Court's May 2003 ruling merely affirmed that a district-court injunction was improper and returned the case to the lower courts for merits determination ? the Walsh litigation may materially impact how prescription drugs are priced.
Long Term Care
Connie A. Raffa of Arent Fox LLP
As our population ages, increasing numbers of individuals will require long term health care services. Services provided by home health agencies allow elderly individuals to receive medical and supportive assistance while remaining at home. Assisted living facilities serve those who cannot live on their own, i.e. , they require assistance with bathing, dressing, ambulating and the other activities of daily living. For those who require more complex or round-the-clock health services, nursing homes may be the best alternative.
Protecting the Rights of Older Americans
Dept. of Health and Human Services
Brochure from the Administration on Aging which describes Title VII, the Vulnerable Elder Rights Protection Program.
The Medicaid Application Process
McMahon Law Firm, Attorney and Counselor at Law
In order to qualify for Medicaid benefits you should first speak to an attorney who is.
The Link Between Medicaid and the Immigration Provisions of the Personal Responsibility and Work Opportunity Act of 1996
Dept. of Health and Human Services
Fact sheet prepared by the Department of Health and Human Services regarding the link between Medicaid and the Immigration Provisions of the Personal Responsibility and Work Opportunity Act of 1996.
Areas of Career Specialization: Health Law
Cadwalader, Wickersham & Taft LLP
In our column of July 30, 1998, we explored the many aspects of health law, which is really a variety of legal spec.
Information Memorandum Regarding Children's Health Insurance Program--Children with Disabilities
Dept. of Health and Human Services
Memorandum from the Department of Health and Human Services to state agencies providing them with information on implementation of the Children's Health Insurance Program.
Legal Rights Of Senior Citizens
This article tells you about some of your legal rights as a senior citizen and it explains how you can protect those rights.
Client Alert: APRIL 2000
Kenneth J. Yood of Paul, Hastings, Janofsky & Walker LLP
This article reviews the new regulations issued by the Health Care Financing Administration (HCFA) setting forth the requirements to obtain and maintain provider-based status under the Medicare Program.
Florida Legislature Amends Patient Self-Referral Act
Broad and Cassel
In the dying minutes of the 1999 session , the Florida legislature amended the Florida Patient Self-referral Act (t.
Nursing Home Cost
Estate Planners of Arkansas, P.A.
NURSING HOME COST: You could lose your life's saving in a stay at the nursing home. HOW MUCH DOES IT COST TO ST.
How to Report Medicare Fraud and Abuse
Dept. of Health and Human Services
Brochure for consumers from the Department of Health and Human Services which provides the steps to take when reporting Medicare fraud.
Medicare Fraud Tips
Dept. of Health and Human Services
List of tips prepared by the Department of Health and Human Services which will help consumers detect fraud in their Medicare services.
Looking Closely at Nursing Home Care
Motschenbacher & Blattner LLP
How can a family pay for all the expenses associated with long term care? Nationwide, annual charges average over $.
Long Term Health Care and Medicaid Planning
Law Office of Daniel G. Parsons
Since people are living longer, planning for the possibility of long term health care is becoming a critical .
Supplemental Needs Trusts
McMahon Law Firm, Attorney and Counselor at Law
If a client has a disabled or retarded child it is very important to ascertain whether that child is receiving money from any government program such as Medicaid or the Supplemental Security Income Program (SSI).
OIG Issues Guidelines for Voluntary Disclosure of Health Care Fraud
Dykema Gossett PLLC
On October 21, the Department of Health and Human Service's Office of Inspector General (OIG) released its Provider.
Prospective Payment System Final Rule Implementation Delayed
Bruce D. Armon of Saul Ewing LLP
Shortly after the June 2000 issue of Update went to print, the Health Care Financing Administration (HCFA) announce.
Increased Federal Matching Rates for Extra Administrative Costs of Eligibility Determination Under Welfare Reform
Dept. of Health and Human Services
Fact sheet prepared by the Department of Health and Human Services regarding the implications for Medicaid eligibility systems and responsibilities under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Social Security: Disability Based On Drug Addiction Or Alcoholism
Social Security Administration
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) disability benefits and Medicare and Medicaid coverage based on those benefits is not available to people who are disabled because of drug addiction and/or alcoholism. This publication explains this law.