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Dental Practice and DSO to Pay $5.1 Million to Settle False Claims Allegations

The Federal and Indiana State government recently announced that two dental firms agreed to pay more than $5.1 million to settle allegations that they submitted false claims to Indiana's Medicaid program. ImmediaDent of Indiana, LLC, and its administrative services provider, Samson Dental Partners, LLC, were accused of billing straightforward tooth pullings as surgical operations and billing for deep cleanings that were either not required and/or performed. According to the settlement,...

New Medicare Shared Savings Program Proposed Rule for Accountable Care Organizations

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule, which would institute a number of major changes to the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). The proposed rule, which creates a redesigned program titled "Pathways to Success," changes the overall structure of the MSSP, and requires ACOs to assume more risk than they are required to under the current MSSP. Under the...

CLIENT ALERT: The “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” Passes Both Houses of the New Jersey Legislature

A bill intended to rein in out-of-network charges and promote transparency regarding insurance coverage and physician and hospital fees is headed to governor Phil Murphy's desk this week after nearly a decade of debate. The bill contains a number of provisions which will have a serious impact on all licensed New Jersey healthcare providers, especially those who own medical facilities such as Ambulatory Surgical Centers (ASC's). A few of the...

The Growing Threat of Cyber Extortion in Healthcare

Cyber extortion, or the act of cybercriminals demanding payment through the use of or the threat of malicious activity against a victim, has increasingly become the method of choice for hackers who are trying to profit from digital crime. Because health care providers store and maintain large amounts of protected health information and other sensitive personal data, cybercriminals frequently target such individuals or organizations. Such attacks can cause serious damage,...

CMS Proposes Changes to Bundled Payment Requirements

Last month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule which would eliminate the requirement that beginning January 1, 2018, providers would be required to participate in certain mandatory bundled payment programs. The proposed rule seeks to cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model, and revise certain aspects of the Comprehensive Care for Joint Replacement (CJR) model. These alternative payment...