Posted by Jason Greis on October 18, 2009 under Articles | 
Recent substantive and procedural amendments to the Federal False Claims Act (“FCA”) enacted under the Fraud Enforcement and Recovery Act of 2009 (“FERA”) are expected to fuel growth in the number of whistleblower-generated cases brought against healthcare providers—including LTACHs. The FERA amendments closed a loophole in the FCA that previously prevented overpayment cases from being brought against providers. The FCA now allows whistleblowers to bring false claims actions against providers who knowingly and improperly keep government funds paid to them in error. FERA was signed into law May 20, 2009. Read More...
Tags: allison engine, attorney general, claim, contractor, fera, fraud enforcement and recovery act, greisguide, greisguidetoltachs, health care, healthcare, hospital, intent, ltac, LTACH, LTCH, Medicaid, medicare, oig, supreme court
Posted by Jason Greis on September 29, 2009 under Articles |
Section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“MMSEA”) established, among other things, a three-year temporary moratorium on the establishment of new LTACHs and LTACH beds, subject to certain limited exceptions. When rules implementing the moratorium were released by CMS in an Interim Final Rule on May 22, 2008, CMS did not specify which change of ownership and facility relocation activities by existing LTACHs and LTACH satellite would continue to be permissible under the moratorium. In fact, CMS specifically advised the industr that such questions should be directed to their Medicare Administrative Contractors, and that the CMS Regional Office would address specific situations on a case by case basis. Read More...
Tags: asset sale, Change of Ownership, chow, co-locate, consolidate, consolidation, development, greisguide, greisguidetoltachs, hospital, jason greis, long term acute care hospital, long term care hospital, ltac, LTACH, LTCH, medicare, merge, merger, mmsea, provider agreement, provider number, Relocation, satellite, Section 114, stock sale, transaction
Posted by Jason Greis on September 17, 2009 under Articles |
I. Political Overview. Read More...
Tags: accountable care organization, aco, bundled, bundling, chairman's mark, Chuck Grassley, extension, gang of six, healthcare, hha, home health, hospice, hospital, innovation center, inpatient rehabilitation, irf, jason greis, Jeff Bingaman, Kent Conrad, long term acute care hospital, long term care hospital, ltac, LTACH, LTCH, max baucus, Medicaid, medicare, Mike Enzi, mmsea, mona mohib, Olympia Snowe, overhaul bill, post-acute, quality reporting, senate finance committee, skilled nursing, snf, value-based purchasing
Posted by Jason Greis on July 14, 2009 under Articles, Industry News |
Section 114(b) of the Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”) required the Secretary of Health and Human Services to conduct a study on the feasibility of establishing national LTACH facility and patient criteria for purposes of determining medical necessity, appropriateness of admission, and continued stay at, and discharge from, LTACHs. The Centers for Medicare and Medicaid Services (“CMS”) awarded a contract for this study to Research Triangle Institute International (“RTI”), which was previously awarded a contract in 2005 to evaluate the feasibility of developing patient and facility level characteristics for LTACHs that could distinguish LTACH patients from those treated in other acute care settings. RTI was scheduled to submit its most recent report required under the MMSEA to Congress by June 2009. According to an anonymous source within CMS, the agency is presently reviewing the report’s recommendations for legislation and administrative actions and CMS hopes to post the report on its website by the end of July 2009. Read More...
Tags: cms, greisguide, greisguidetoltachs, hospital, jason greis, ltac, LTACH, LTCH, Medicaid and SCHIP Extension Act, medicare, mmsea, post-acute, report, research triangle, RTI, study
Posted by Jason Greis on May 11, 2009 under Articles |
A California hospital recently challenged the decision of a Medicare recovery audit contractor (RAC), alleging that the RAC unlawfully reopened claims submitted by the hospital. Palomar Medical Center v. Johnson, S.D. Cal., No. 3:09-cv-00605-BEN-NLS (S.D. Cal. complaint filed 3/24/09). The case is the first since the inception of the Medicare RAC program to challenge the ability of RACs to reopen Medicare claims more than one year after payment, and its outcome will significantly affect the ability of hospitals to generally treat Medicare payments as final a year after receipt. Read More...
Tags: alj, greisguide, greisguidetoltachs, hospital, ltac, LTACH, LTCH, mac, mcguirewoods, medicare, palomar, PRG-Schultz, RAC, recovery audit contractor
Posted by Jason Greis on April 3, 2009 under Articles, Whitepapers |
The current Congressional fervor to overhaul the U.S. health care system has some policy makers discussing how to change the way post-acute providers, including LTACHs, home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and outpatient-based hospital rehabilitation facilities are compensated for treating Medicare beneficiaries. One solution proposed by President Barack Obama, the Congressional Budget Office, and certain congressional leaders is to bundle payments for acute care and post-acute care services provided within the first thirty days after being discharged from an acute care hospital. This bundling model has been proposed many times since the early 1980s as a measure to control escalating post-acute care costs, decrease the number of preventable acute-care hospital readmissions, and increase Medicare cost savings but has never received broad support-until now. Read More...
Tags: acute, budget, bundle, bundling, CBO, congressional budget office, greisguide, greisguidetoltachs, home health, jason greis, ltac, LTACH, LTCH, medicare, obama, post-acute, skilled nursing facility, snf
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