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RACs to begin extrapolating and defending appeals

Baker & Hostetler LLP
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USA
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April 14 2011

At the recent American Health Lawyers Association's Institute on Medicare and Medicaid Payment Issues conference, the Centers for Medicare & Medicaid Services (CMS) officials provided insight into future Recovery Audit Contractor (RAC) plans for the coming year, including an effort to move away from the term RAC to Recovery Auditor and plans to update the CMS website

Medicare hearing and appeals: OMHA centralizes ALJ hearing docket

Baker & Hostetler LLP
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USA
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March 1 2012

Effective January 17, 2012, the Office of Medicare Hearing and Appeals (OMHA) implemented a centralized docketing system requiring ALJ hearing requests related to Qualified Independent Contractor (QIC) decisions nationwide to be submitted to a Centralized Docketing Office in Cleveland, rather than OMHA field offices

CMS clarifies physician supervision of incident-to services provided on an outpatient basis

Baker & Hostetler LLP
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USA
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June 10 2010

On May 28, 2010, CMS clarified the physician supervision requirements for diagnostic and therapeutic services provided to hospital outpatients

CMS proposes increased rewards for reporting fraud and abuse

Baker & Hostetler LLP
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USA
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May 2 2013

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward

More hospitals face expulsion from Medicare following unannounced complaint investigations

Baker & Hostetler LLP
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USA
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April 12 2012

A Pennsylvania hospital faces termination from the Medicare program following an unannounced complaint investigation by state health authorities in late March that found "there was a significant threat to the well-being of the patients at the facility."

Texas Medicaid RACs announced

Baker & Hostetler LLP
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USA
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September 27 2012

The Texas Health and Human Services Commission (HHSC) recently announced a tentative contract award for the Texas Medicaid Recovery Audit Contractor (RAC) contract to both CGI Federal, Inc. and Health Management Systems, Inc. (HMS

Little recourse in intermediary's refusal to reopen

Baker & Hostetler LLP
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USA
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December 10 2009

On November 24, 2009, the Seventh Circuit issued a decision narrowing its own prior ruling in Edgewater Hospital v. Bowen, 857 F.2d 1123 (7th Cir. 1989), in which it held that an intermediary's decision not to reopen an issue can constitute an appealable determination

OCR HIPAA audit and site visit pilot program implemented

Baker & Hostetler LLP
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USA
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December 13 2011

In an effort to comply with Section 13411 of the HITECH Act, the Office for Civil Rights (“OCR”) recently announced the implementation of a pilot program to audit covered entities and business associates to ensure they are complying with the HIPAA Privacy and Security Rules and Breach Notification standards

OIG unveils most wanted healthcare fugitives list

Baker & Hostetler LLP
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USA
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February 3 2011

Today the U.S. Department of Health and Human Services Office of Inspector General (OIG) introduced its Most Wanted Fugitives List in an effort to shine a spotlight on individuals sought by authorities on charges of healthcare fraud and abuse

Texas Medicaid RAC and intent to delay implementation announced

Baker & Hostetler LLP
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USA
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April 26 2012

The Texas Health and Human Services Commission (HHSC) has announced a "tentative contract award" for the Recovery Audit Contractor (RAC) Program for Texas Medicaid to CGI, Federal, Inc

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