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Payment Matters
November 25, 2008
Ninth Circuit Requires Documented Protested Costs or Risk False Claims Liability
By: Thomas W. Coons and Mark A. Stanley
In U.S. v. Borseau, the Court of Appeals for the Ninth Circuit recently upheld False Claims Act (FCA) liability for a Provider that failed to properly document disputed items on cost reports. The Borseau case serves as a cautionary tale for providers, especially since the new Provider Reimbursement Review Board (PRRB) rules are likely to increase the number of cost reports filed under protest.
Click to continue...The OIG's 2009 Work Plan — What's in it for Long-term Care & Community-based Providers?
Providers conducting annual updates to their compliance plans should consider, among other available guidance, the Department of Health and Human Services, Office of the Inspector General's (OIG) focus areas set forth in the OIG's fiscal year (FY) 2009 Work Plan.
In a previous issue of Payment Matters, we discussed the release by the OIG of its FY 2009 Work Plan and, specifically, the provisions within the Work Plan that will affect hospital providers. We now focus on the Work Plan provisions that address perceived issues involving home health agencies, nursing homes, hospice providers, and other providers rendering services in these long-term care settings.
Click to continue...Hopeful News for Providers on DSH/SSI Issue
The Federal District Court for the District of Columbia recently issued an order in the Baystate disproportionate share hospital (DSH) supplementary security income (SSI) case: (1) vacating the decision of the Administrator below and ordering the Secretary of Health and Human Services (Secretary) to recalculate and pay the hospital further sums consistent with the court's opinions and to pay interest, (2) finding that the earlier ordered further evidentiary hearing and addition explanation by the Secretary are no longer necessary, and (3) denying Baystate's request that the court retain jurisdiction over this case until full resolution.
Click to continue...CMS Updates Home Health Payment Rates for CY 2009
By: Carel T. Hedlund
Given the substantial changes CMS made to the Medicare Home Health Prospective Payment System (HH PPS) methodology for calendar year (CY) 2008, CMS is making few changes for CY 2009. In a Notice published in the Federal Register on November 3, 2008, CMS estimates that Medicare payments to home health agencies (HHAs) will increase by an estimated additional $30 million next year. The highlights of this CY 2009 Notice, effective January 1, 2009, include...
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