The False Claims Act (“FCA”) is a Federal statute originally enacted in 1863 as a response to fraud from defense contractors during the American Civil War. Under the FCA (31 U.S.C. §§ 3729 – 3733), it is a crime for any person to knowingly submit false or fraudulent claims for payment to the United States government. Those who violate the FCA are liable for treble damages plus a per-claim monetary penalty (calculated to align with inflation). … More
Category Archives: Medicare
Before getting into the weeds of how notice-and-comment rulemaking requirements interact with CMS’s ability to set payment policy – Medicaid and the Law would like to formally introduce its readers to Alexander Somodevilla (Alex), a new Associate in the Washington, DC office who will become a regular contributor to the blog. Alex has a deep background in Medicaid and Medicare law and policy, and is passionate about the issues and far-reaching impact of these programs.… More
One of the things that gets drummed into your head working with Medicaid is this: Medicaid is a payer of last resort. Medicaid can only pay for a health care service when there is no other payer available. If a Medicaid beneficiary has virtually any other source of health insurance coverage, that coverage pays first.
This requirement is set forth in the basic rules of the Medicaid program;… More
Attorneys Ross Margulies and Tom Barker to Speak at AHLA’s Institute on Medicare and Medicaid Payment Issues
Foley Hoag attorneys and Medicaid and the Law bloggers Ross Margulies and Tom Barker are presenting at the American Health Lawyers’ Association Annual Institute on Medicare and Medicaid Payment Issues in Baltimore this week.
Ross’s presentation will address Medicare and Medicaid payment issues for innovative therapies. Tom’s will provide an update on Medicaid § 1115 waivers.… More
Court Case Involving Massachusetts Health Care Law Shows Relationship Between Medicare Payments and Medicaid
In 2006, former Massachusetts Governor Mitt Romney signed Chapter 58 of the Massachusetts Acts of 2006 into law. Chapter 58 was designed to ensure that all Massachusetts residents would have access to some form of health insurance, and it accomplished this through reforms to the individual insurance market; subsidies to purchase health insurance; and an expansion of the Massachusetts Medicaid program, known as “MassHealth.” Many observers have suggested that the enactment of Chapter 58 in Massachusetts paved the way for enactment of the Affordable Care Act at the federal level four years later (although Governor Romney strenuously denied this during his campaign for President in 2012).… More
Some things in the world would be much simpler if they stayed separate, but we all can’t have what we want. As health care lawyers, Tom Barker and I are used to navigating complex and intersecting fields of law such as tax, contracts, fraud and abuse, insurance, and federal health care program coverage and reimbursement. But we also know a bit about immigration law from our pro bono work representing individuals seeking lawful status in the U.S.… More
On January 20, 2017, President Donald Trump signed an Executive Order (EO) entitled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” to signal a clear message that “repeal and replace” of the Affordable Care Act (ACA) is a priority for the new administration. On the same day, the White House Chief of Staff, Reince Priebus, issued a memorandum to executive agencies ordering an immediate “regulatory freeze” and directing the Departments to send no regulation to the Federal Register “until a department or agency head appointed or designated by the President .… More
Here is a video from my recent guest lecture at George Mason University about Medicare and U.S. Healthcare Spending.
On July 30, the country marks the 50th anniversary of the enactment of the Medicare and Medicaid programs. Fifty years ago, President Lyndon Johnson signed the two programs into law.
I am very proud to say that I have been involved in health care law and policy for more than one-half of the lifetime of these important social programs. My first job out of college – right after the 15th anniversary of Medicare and Medicaid –… More