Medicare Advantage programs are more common these days, with a significant portion of Medicare beneficiaries currently enrolled in different programs. Known commonly as MA plans, the Medicare Advantage programs are issued by Medicare Advantage Organizations (MAOs)—usually, insurance companies.
Also known as a Medicare audit or a MAC audit, the Recovery Audits Contract (RAC) program is an aggressive campaign seeking reimbursement from healthcare service providers. These audits have become increasingly frequent over the past few years, and they will continue to for the foreseeable future. Whenever a healthcare facility gets hit with a Recovery Audit Contractor program, they could be under significant threat. The Medicare RAC audit examin...
Nick Jurkowitz recently joined Jim Parker on the Hospice News podcast, Elevate. The podcast episode takes a look at False Claims Act cases and discusses why they are a leading legal concern for hospice providers as the industry comes under ever-increasing regulatory scrutiny. Nick provides insight on how hospices can ensure compliance to prevent and defend against potential questions of their patients’ eligibility for hospice. Click the link to listen to the full podcast episode....
Ben Fenton was recently quoted in Julia Ries' Healthline article "Interpol Warns Fake COVID-19 Vaccines May Pop Up Online,” which covers the topic of possible fraudulent COVID-19 vaccines. Interpol released a warning recently expressing their concern over illegitimate vaccines. Ben commented on the possibility of these fraudulent vaccines and advised caution. “My advice is to always be suspicious, and if it sounds too good to be true, then it probably is,” Ben said. “Taking anything that is not FDA-approved can lead to extreme outcomes, including death.” “The U.S. Im...
Ben Fenton was recently interviewed by Lina Zeldovich for her Medical Bag article "Repealing the Affordable Care Act Could Hurt Physicians and Hospitals." In the piece, Ben discusses how reimbursement rates could possibly be impacted by an ACA repeal, and how physicians and doctors often have to fight for payment. "You’d have less patients in the marketplace and it could make the reimbursement rates go back up,” Ben says, but it’s not exactly clear. To read the full article, click Continue Reading
Nick Jurkowitz was recently quoted in Jim Parker’s Hospice News article “U.S. Supreme Court May Hear Hospice FCA Case.” The article focuses on a False Claims Act case involving the hospice provider Care Alternatives. Nick comments on how this case, which could be heard before the Supreme Court, may affect hospice providers. “To allow false claim act liability in a situation where you have reasonable physicians who differ on opinions of treatment or prognosis will undoubtedly send a chilling message to physicians and hospice care organization. Physicians need to be free to e...
Ben Fenton recently wrote the expert opinion piece "Health Providers Need COVID-19 Biz Immunity Law” for Law360. The piece focuses on the Safe to Work Act, why physicians need COVID-19-related medical liability protections, and the controversy surrounding the rationing of care during the pandemic. Below are some excerpts from the article. The American Medical Association has stated that without legislative protection, physicians could potentially face litigation for, "suspending elective, in-person visits and procedures; being assigned to provide care outside the physician's gene...
Nick Jurkowitz was recently interviewed by Jim Parker for his Hospice News article "Health Care Lawyer Nick Jurkowitz: Fraud is a Top Concern for Hospices.” In the piece, Jim speaks with Nick about the hurdles that hospices are facing in 2020 and legal concerns to consider ahead of 2021. Nick begins by discussing the most pressing legal concerns for hospice providers. "Hospices are a targeted area in a highly regulated arena. Fraud is always the first and foremost concern you’d have in that type of industry. That could range anywhere from civil or criminal. The government cou...
Ben Fenton was recently quoted in Ayanna Alexander’s Bloomberg Law article “Broken Ventilators Require Easier Fixes, Black Leaders Demand,” which discusses the rising demand for usable ventilators as black communities continue to bear the brunt of coronavirus deaths. According to Ben, ventilator manufacturers may fear potential product liability claims if the devices they help repair malfunction. “If the manufacturer tries to make a good faith effort, which we want them to do, and say we’re going to work with hospitals so they can repair these defective machines, and then...