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The NC MCOs: Jurisdiction Issues and Possible Unenforceable Contract Clauses...
According to NC Superior Court, OAH (and I) has (have) been right all along…OAH does have jurisdiction over the MCOs. And you cannot contract away protections allowable by statute. Before I went to...
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Personal Care Services: Will the Fear of the “F” Word (Medicaid Fraud) Cause...
In my career, I call it the “F” word: Fraud. Its existence and fear of existence drives Medicare and Medicaid policies. It is without question that Medicare and Medicaid fraud needs to be eliminated....
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The Future of Medicaid, a POPPED Balloon, and Proposals
There are more people on Medicaid than Medicare. Think about that. There are more people in America who qualify for Medicaid than Medicare. Yet, as a nation, we spend more on Medicare than Medicaid....
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CCME’s Medicaid Audit Bloopers: Ring Around the Rosie, We All Fall Down
“Ring Around the Rosie.” What a fantastic children’s rhyme; it brings back nostalgic memories of my daughter being young. We would sing “Ring Around the Rosie,” while holding hands and running in a...
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Medicaid, Medicare, Nursing Facilities, and Death and Taxes: Our Uncertain...
There are few “knowns” in life. In 1789, Benjamin franklin penned a correspondence to Jean-Baptiste Leroy, in which he wrote, “Our new Constitution is now established, and has an appearance that...
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General Assembly in Full Swing: What Medicaid Bills Are On the Agenda??
It’s that time of year again. The legislators are back in town. Moral Mondays resume. And all eyes are on the General Assembly. But, this is the short session, and the General Statutes limit the powers...
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Knicole Emanuel to Appear on UNC-TV Tonight! Tune In at 7:30pm!
Heather Burgiss, a UNC-TV journalist, created a 3-part television series called, “Mental Health Services in NC.” Part 1 will air tonight on UNC-TC at 7:30, and I will be discussing the important topic...
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Medicare Appeals to OMHA Reaches 15,000 Per Week, Yet Decisions Take Years;...
When you are a health care provider and make the business determination to accept Medicare or Medicaid, you are agreeing to deal with certain headaches. Low reimbursement rates and more regulations...
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Right Wing, Left Wing: Does It Equal a More Balanced Senate Bill 744?
Our Senate put forth Senate Bill 744 with radical and shocking changes to our Medicaid system. However, one section of our General Assembly cannot create law. Both sides,the Senate and the House, much...
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NCTracks’ One-Year Anniversary Is Celebrated with a Newly-Released, NCTracks,...
Happy Anniversary, NCTracks!!!! Tomorrow is the one-year anniversary of NCTracks going live. DHHS TV released a video touting the wonderful success of NCTracks, despite its, admittedly, rocky start...
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Can DHHS Do Anything Right? State Auditor Finds DHHS’ Provider Eligibility...
A new audit by the State Auditor shows ANOTHER problem at DHHS. This comes on the heels of another audit earlier this month finding that NCTracks is problematic. Here is the link: State Audit More...
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Williams Mullen Hosts “The State of the State of Health Care” Panel Discussion
Williams Mullen is hosting a free panel discussion on “The State of the State of Health Care.” Please see below! The panelists will be Rep. Nelson Dollar, Steven Keene, General Counsel to the NC...
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Knicole Emanuel Speaks About CSC Fraud Investigation on ABC
I was interviewed by Heather Waliga, ABC News, last Friday about the U.S. Attorney’s lawsuit against Computer Sciences Corporation (CSC) accusing CSC of hundreds of millions of dollars of Medicaid...
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New Mexico Senator Proposes Forefront State Legislation to Provide Due...
Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new legislation protecting...
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Source: [New Mexico] Human Services Secretary Squier Resigns!
“Gov. Susana Martinez’s controversial Human Services Department Secretary Sidonie Squier resigned on Thursday, sources inside the department confirmed,” according to the Santa Fe New Mexican. Patsy...
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Obama’s Executive Order, Its Impact on Health Care Costs, and the...
Pres. Barack Obama will address the nation tonight at 8 pm (Thursday, November, 20, 2014). He is expected to discuss his executive order that will delay deportations of up to 5 million migrants. What...
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OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!
With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are...
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Medicaid Reform in a House Divided and MCO, ACO…Who Cares?
We are living in the most polarized society in recent American history. A recent study shows that the feeling of political partisanship has more than doubled over the past 2 decades. So since 1995,...
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NC Medicaid Reimbursement Rates for Primary Care Physicians Slashed; Is a...
Here is my follow-up from yesterday’s blog post, “NC Docs Face Retroactive Medicaid Rate Cut.” Nearly one-third of physicians say they will not accept new Medicaid patients, according to a new study....
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Judge Orders State’s Termination of Provider’s Medicaid Contract To Be...
THE CASES LISTED BELOW ARE ILLUSTRATIVE OF THE MATTERS HANDLED BY THE FIRM. CASE RESULTS DEPEND UPON A VARIETY OF FACTORS UNIQUE TO EACH CASE. NOT ALL CASE RESULTS ARE PROVIDED. CASE RESULTS DO NOT...
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