By Deniza Gertsberg, Esq., on July 6th, 2018 New York State Office of the Medicaid Inspector General (OMIG) annual 2018-2019 Work Plan highlights three areas of concern for the agency: (1) provider compliance; (2) identifying and addressing fraud, waste and abuse in the program; and (3) improving methods of detecting fraudulent activities.
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By Deniza Gertsberg, Esq., on May 31st, 2018 Recent analysis by the Comprehensive Error Rate Testing (CERT) initiative of physical therapy claims revealed that insufficient documentation contributed to improper payments issued to providers.
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By Deniza Gertsberg, Esq., on March 15th, 2018 The Division of Consumer Affairs (Division) is proposing to amend the Prescription Monitoring Program (PMP) rules to require New Jersey licensed pharmacies and registered out-of-State pharmacies to electronically transmit information to the Division about prescriptions filled for gabapentin.
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By Deniza Gertsberg, Esq., on October 17th, 2017 The New Jersey Division of Consumer Affairs (“Division”) recently proposed amendments and a new rule to implement a 2014 law concerning health care service firms.
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By Deniza Gertsberg, Esq., on October 3rd, 2017 The Bureau of Compliance (BOC) within the New York State Office of the Medicaid Inspector General (OMIG) recently performed an assessment of providers’ compliance programs. The results indicate that providers sometimes fail in relatively less complicated and readily addressable ways.
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By Deniza Gertsberg, Esq., on September 4th, 2017 Several of New Jersey’s professional licensing Boards recently adopted new controlled dangerous substance prescription requirements. Prescribers should be aware of the changes to avoid running afoul of the new regulations.
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By Deniza Gertsberg, Esq., on July 13th, 2017 In recognition of limitation of certain electronic prescribing software the NYS Health Commissioner approved a new blanket waiver for electronic prescribing requirements.
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By Deniza Gertsberg, Esq., on June 12th, 2017 The Centers for Medicare & Medicaid Services (CMS) has once again issued guidance reminding providers that federal law bars Medicare providers from billing a Qualified Medicare Beneficiaries (QMB) under any circumstances.
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By Deniza Gertsberg, Esq., on May 17th, 2017 The New York State Office of the Medicaid Inspector General (OMIG or agency) has recently issued its 2017-2018 Workplan. The Workplan identifies key areas of OMIG’s focus impacting health care providers and suppliers.
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By Deniza Gertsberg, Esq., on April 12th, 2017 Providers, suppliers and their billing staff need to be aware of the following recent changes to the Medicare program.
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By Deniza Gertsberg, Esq., on March 6th, 2017 The Office of Inspector General (OIG) recently published a final rule that implements OIG’s expanded statutory exclusion authority. The final rule included a number of provisions that impact providers and suppliers.
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By Deniza Gertsberg, Esq., on February 22nd, 2017 Scope of practice matters and New Jersey dentists who fail to comply with the requirements for administering injectable pharmacologics such as Botox or Restylane may be subject to discipline.
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By Deniza Gertsberg, Esq., on February 16th, 2017 A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program.
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By Deniza Gertsberg, Esq., on February 1st, 2017 Failure by a covered entity to timely report a breach of protected health information (PHI) resulted in the first of its kind settlement in the amount of $475,000.
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By Deniza Gertsberg, Esq., on January 16th, 2017 New York State is working to expand the State’s medical marijuana program.
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By Deniza Gertsberg, Esq., on December 29th, 2016 Read the latest Medicare updates impacting prescriber enrollment requirement for Part D drugs, billing for telehealth services, and DME prior authorization in 2017.
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By Deniza Gertsberg, Esq., on December 15th, 2016 Many healthcare providers and suppliers cheered when Congress did away with the sustainable growth rate (SGR) formula by passing the Medicare Access and CHIP Reauthorization Act (MACRA). No longer did they have to worry on an annual basis if a patch to prevent double digit cuts to reimbursement will be passed. But a new reimbursement methodology under MACRA leaves many practitioners wondering if they will meet the metrics or face payment cuts.
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By Deniza Gertsberg, Esq., on November 1st, 2016 The Office of Civil Rights (OCR) within the U.S. Department of Health and Human Services, recently issued a Non-discrimination in Health Care Programs and Activities rule. This final rule implements Section 1557 of the Patient Protection and Affordable Care Act (ACA). Section 1557 builds on existing civil rights laws and prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities and applies broadly to many providers and suppliers.
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By Deniza Gertsberg, Esq., on October 11th, 2016 Under the Affordable Care Act (ACA), providers and suppliers who bill for services furnished by an excluded or an unlicensed person are considered to have received an overpayment from Medicare which must be reported and returned within 60 days of “identifying” the overpayment (claims-based overpayment). New Jersey Medicaid recently reminded providers that a similar requirement for Medicaid and Medicaid Managed Care providers exists in New Jersey and will be enforced.
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By Deniza Gertsberg, Esq., on September 29th, 2016 The passage of the Patient Protection and Affordable Care Act (ACA) heralded a new era for provider enrollment and revalidation by enhancing provider and supplier screenings. The Centers for Medicare & Medicaid Services (CMS) now requires certain providers to be fingerprinted in order to continue participating in the Medicare program. Medicare contractors (MACs) have been sending notices to impacted providers and suppliers advising them to complete fingerprinting within a specified time-frame.
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