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The Daily Scan

Last Updated: 8:50 AM EST

Medicaid & Medicare

  • In response to a Federal District Judge's ruling last week blocking Medicaid work requirements in Kentucky, Governor Matt Bevin's administration announced yesterday that dental and vision benefits for existing Medicaid beneficiaries will be cut as a component of program restructuring. Their official statement reads: "It is great that people are talking about the importance of routine vision and dental coverage. Unfortunately, annually fewer than 10% of Medicaid beneficiaries have taken advantage of this coverage. Kentucky HEALTH’s My Rewards program is designed to INCREASE people’s use of their vision and dental coverage by incentivizing them with earned credits to the My Rewards Account. However, when Kentucky HEALTH was invalidated by the court, the My Rewards program was eliminated, and there is no longer a funding mechanism in place to pay for dental and vision services." As per the Louisville Courier Journal, this change affects approximately 460,000 beneficiaries enrolled in the Alternative Benefits Plan. (Official Statement: Kentucky.gov)

  • Yesterday, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care. “Today’s proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” said CMS Administrator Seema Verma. “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.” (CMS.gov)

  • Yesterday, the Centers for Medicare and Medicaid Services (CMS) released three reports that provide important information on the current condition of the Federal and State-based Exchanges and state individual health insurance markets. Taken together, these reports show that state markets are increasingly failing to cover people who do not qualify for federal subsidies even as the Exchanges remain relatively stable. Steps taken by CMS in 2017, as the reports show, improved the performance of the Exchanges and began addressing market stability issues. However, serious problems persist. Rising premiums have left unsubsidized people with poor health coverage options and dramatically increased the federal cost of premium subsidies. (CMS.gov)


  • United States Attorney Maria Chapa Lopez announced yesterday that FWC Urogynecology, LLC, a network of urogynecology practitioners throughout Florida, has agreed to pay the United States $1,700,000.00 to resolve allegations that it violated the False Claims Act by knowingly billing the government for services that were inflated or that it did not provide. The settlement relates to FWC Urogynecology’s use of Medicare billing codes with modifier 25. A provider’s use of a modifier on healthcare claims can allow additional payment from government programs. Here, FWC Urogynecology knowingly billed modifier 25 for services that were not billable or that it did not provide. (Justice.gov)

  • The U.S. Attorney’s Office for the Southern District of Indiana announced late last week that the former CEO of American Senior Communities (ASC) James Burkhart was sentenced to 114 months imprisonment in a massive fraud, kickback, and money laundering conspiracy. U.S. Attorney Josh Minkler commented: “In spite of receiving a salary of over $1 million, Burkhart abused his official position of trust to steal tax payer dollars intended to benefit this community’s sick, elderly and mentally challenged,” said Minkler. “Because this thief was motivated by nothing other than corruption and greed, we sought a justifiably harsh sentence. Hopefully, the sound of the prison door slamming shut on this 9.5 year sentence will deter other officials from the culture of corruption and greed we see in this district.” (Justice.gov)

There will be no FHASTpulse tomorrow morning because of the holiday. From everyone at FHAS, we wish you and yours a safe and happy Fourth of July celebration! We'll see you back here on Thursday.

#Litigation #Medicare #Medicaid


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