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The Daily Scan

Last Updated: 1:00 PM EST

Medicare & Medicaid

  • Yesterday the Centers for Medicare & Medicaid Services (CMS) announced the Maternal Opioid Misuse (MOM) model, an important step in advancing the agency’s multi-pronged strategy to combat the nation’s opioid crisis. The model addresses the need to better align and coordinate care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. The primary goals of the model are to improve quality of care and reduce expenditures for pregnant and postpartum women with OUD as well as their infants; increase access to treatment, service-delivery capacity, and infrastructure based on state-specific needs; and create sustainable coverage and payment strategies that support ongoing coordination and integration of care. The CMS Innovation Center will execute up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery partners” in their communities. The MOM model will have a five-year period of performance with different types of funding. (CMS.gov)

  • In accordance with Section 1899B(g)(1) of the Social Security Act, which requires CMS to provide for the public reporting of SNF provider performance on the quality measures, today CMS announced the inaugural release of the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) quality data on Nursing Home (NH) Compare. The law requires certain post-acute care (PAC) providers, including SNFs, to report provider performance data on quality. The Improving Medicare Post-Acute Care Transformation (IMPACT) Act also requires CMS to publicly report quality measure data submitted by SNFs on certain quality measures specified in the Act. These data can demonstrate how a SNF’s performance on SNF QRP quality measures compares to that of other SNFs, as well as to the national average. These data can showcase a SNF’s ongoing commitment to quality, improving engagement and confidence among staff, residents, caregivers, families, and stakeholders. (CMS.gov)


  • Philadelphia-based Vascular Access Centers L.P., along with its 23 subsidiary and related corporations (collectively “VAC”), has agreed to pay at least $3.825 million to resolve claims that it violated the False Claims Act by billing Medicare for non-reimbursable vascular access procedures performed on End Stage Renal Disease (ESRD) beneficiaries and engaging in an alleged kickback scheme related to referrals for such procedures, the Department of Justice announced yesterday. The settlement resolves allegations that VAC, which currently operates facilities in eight states, billed Medicare for vascular access surgical procedures performed on ESRD beneficiaries, including fistulagrams and percutaneous transluminal angioplasties, without all of the required medical documentation supporting the necessity of the procedures. The settlement also resolves allegations that VAC submitted false claims to Medicare for services that resulted from referrals that VAC had induced through improper remuneration to physician investors and medical directors, in violation of the Anti-Kickback Statute. The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and is instead based on the best interests of the patient. VAC has agreed to pay a minimum of $3.825 million in a series of fixed payments over five years, and could pay up to a maximum of $18,360,794, if certain contingencies are triggered. (CMS.gov)

  • Nikkita Chesney of Bridgeport, CT waived her right to be indicted and pleaded guilty yesterday before U.S. District Judge Victor A. Bolden in Bridgeport to one count of health care fraud and one count of aggravated identity theft. According to court documents and statements made in court, in May 2012, Chesney was employed by a health care provider that provided substance abuse treatment, including a detoxification program located in Bridgeport, when she was approached by Juliet Jacob and another individual. Jacob and the other individual operated two businesses, Transitional Development And Training (TDAT) and It Takes A Promise (ITAP), which provided social and psychotherapy services. At the suggestion of the other individual, Chesney began to steal the personal identification information of Medicaid clients who were patients of her employer. The personal identifying information included the patients’ Medicaid identification number, Social Security Numbers and dates of birth. Chesney, Jacob and the other individual then used the stolen identity information to bill Medicaid for psychotherapy services purportedly provided by TDAT and ITAP, when the Medicaid clients had never received any such services from TDAT and ITAP. In pleading guilty, Chesney admitted to stealing the identity information of more than 150 Medicaid clients from her employer, and that she and her co-conspirators successfully billed Medicaid for approximately half of those clients. Chesney further admitted that she and her co-conspirators also billed Medicaid for services to other clients that were never provided to those clients. (Justice.gov)


  • The Hill reported yesterday that e-cigarette company Juul Labs has more than doubled its spending on lobbying as it faces regulatory threats from the Trump administration and Congress. Juul spent about $560,000 on lobbying in the third quarter of 2018, which runs from July through the end of September, according to newly released disclosure reports. Juul originally reported spending $1.2 million on lobbying in the third quarter, but later amended that amount that amount to $560,000, calling the incorrect data a filing error. That compares to the $210,000 it spent in the previous quarter — a 166% increase. (TheHill.com)

#Medicaid #Medicare #Legislation #Litigation


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