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New Process for Appealing Medicaid MCOS’ Adverse Claim Determinations

House Bill 492 – New Process for Appealing Medicaid MCOs’ Adverse Claim Determinations On June 7, 2017, Louisiana House Bill 492 (HB 492) was sent to the Governor for executive approval. This Bill establishes a …..

June 16th, 2018|Categories: Medicare & Medicaid|Tags: |

$5.5 Million HIPAA Settlement Underscores Importance of Audit Controls

Memorial Healthcare Systems (MHS) paid the U.S. Department of Health and Human Services (HHS) $5.5 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules …..

February 20th, 2017|Categories: Health Law|

Final Rules on Reimbursement for Off-Campus Provider Based Departments

On Nov. 2, 2015, Congress surprised providers with the passage of Section 603 of the Bipartisan Budget Act of 2015 (the “Act”), which eliminates Medicare Outpatient Prospective Payment System (OPPS) reimbursement for off-campus outpatient provider-based …..

November 3rd, 2016|Categories: Health Law, Provider Operations|Tags: |

Negligent Credentialing of Physicians: Increased Liability for Hospitals

The Louisiana Third Circuit recently held in Billeaudeau v. Opelousas General Hosp. Authority, 189 So. 3d 561 (La. App. 3d Cir. 2016) that a claim for “negligent credentialing” of a physician by a hospital does …..

September 29th, 2016|Categories: Health Law|Tags: |

Department of Justice Doubles Health Care Civil Fraud Penalties starting August 1, 2016

The U.S. Department of Justice (DOJ) published an interim final rule on June 30th that dramatically increased potential civil penalties under the Civil False Claims Act and the Federal Anti-Kickback Statute. Currently, violations of the …..

July 28th, 2016|Categories: Civil Monetary Penalties, Fraud & Abuse Compliance, Health Law|Tags: |

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