Industry Notes

Why This Topic Matters

The notes highlight topics that can affect reimbursement, compliance risk, and policy interpretation in day-to-day practice operations. Readers who work with Medicare billing, Medicaid coverage rules, or federal program compliance can use it to identify areas needing review.

Article Sections

1. Discrimination Costs Doc Federal Funding

   Summarizes a federal civil rights enforcement action involving a provider and the loss of Medicaid funding. The section focuses on HHS OCR activity and a Rehabilitation Act matter.

2. Breakneck Speed Fraud

   Discusses a Department of Justice press release about alleged Medicare fraud and related criminal charges. The note emphasizes the scale and pace of the alleged billing activity.

3. RAC Auditors Target E/Ms During Global As Problem Area

   Reviews CMS guidance on billing evaluation and management services during global surgery periods. The section references Medicare learning guidance and modifier use in the context of global periods.

4. Will Your State Loosen Medicaid Eligibility Requirements?

   Covers an OIG report and CMS policy history regarding state Medicaid home health eligibility rules. The note addresses state policy alignment with federal requirements.