The Daily Scan

July 2, 2018

Last Updated: 9:00 AM EST

Medicaid

  • On Friday, United States District Court for the District of Columbia ruled to block Medicaid work requirements in Kentucky just days before they were set to be implemented. In his opinion, U.S. District Judge James E. Boasberg wrote: "...Plaintiffs’ position is simple: “[T]he purpose of the [Medicaid Act] is to provide coverage and care to the most vulnerable” and, more precisely, “to provide that care generally free of charge.” The Secretary, they believe, “failed to consider adequately” the impact of Kentucky HEALTH on Medicaid coverage. Indeed, he “entirely failed to consider” Kentucky’s estimate that 95,000 persons would leave its Medicaid rolls during the 5-year project. Those failures, they urge, make his decision arbitrary and capricious. Plaintiffs are correct." (ECF.DCD.USCourts.gov)

 

  • CMS Administrator Seema Verma issued a statement on the Federal District Court's Kentucky Medicaid ruling: "Today’s decision is disappointing. States are the laboratories of democracy and numerous administrations have looked to them to develop and test reforms that have advanced the objectives of the Medicaid program. The Trump Administration is no different. We are conferring with the Department of Justice to chart a path forward. In the meantime, we will continue to support innovative, state-driven policies that are designed to advance the objectives of the Medicaid program by improving health outcomes for thousands of low-income Americans." (CMS.gov)

 

  • On Friday, the Centers for Medicare & Medicaid Services (CMS) announced that they are advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk. CMS is seeking public comment on the information collection burdens associated with the demonstration, which is under consideration for formal approval. (CMS.gov)

Litigation

  • South Florida Doctor Andres Mencia was convicted on Friday by a federal jury in Fort Lauderdale, of participating in a conspiracy to distribute a controlled substance. According to evidence admitted at trial, Dr. Mencia ran Adult & Geriatric Institute of Florida lnc. in Oakland Park, Florida. Beginning in or around January 2014 and continuing through October 2017, Dr. Mencia, and his office personnel conspired to perform sham consultations with cash-paying patients. The evidence showed that the true and intended purpose of the consultations was to improperly issue the patients’ prescriptions for opioids and narcotics, such as Oxycodone, OxyContin and Percocet, in exchange for cash payments. Pursuant to Dr. Mencia’s instructions, co-conspirators kept track of the drug-seeking patients by identifying them as “CS” (controlled substance) “patients.” On occasion, Dr. Mencia provided his co-conspirators pre-signed prescriptions to issue the “CS” patients prescriptions for controlled substances in his name. During the course of the conspiracy, Dr. Mencia was not providing a medically meaningful consultation but was in fact acting outside the scope of his professional practice and without legitimate medical purpose. Dr. Mencia is scheduled to be sentenced on September 7. (Justice.gov)

Durable Medical Equipment

  • A recent study conducted by the Office of Inspector General did not detect inappropriate claims for Durable Medical Equipment in Nursing Facilities. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 directs OIG to monitor the appropriateness of Medicare payments for items and services-including durable medical equipment (DME)-provided during stays not covered by Medicare, called "noncovered stays," in skilled nursing facilities (SNFs). Previously in 2006, the OIG found $41.2 million in Medicare payments for inappropriate claims for DME in the same environment. For 2015, the study found that CMS's payment edits did not detect $18.4 million in Medicare payments for inappropriate claims. (OIG.HHS.gov)

 

 

 

 

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