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Zimmerman's Research Guide


Find

Medicare and Medicaid

Most of the relevant legal materials are compiled in CCH Medicare and Medicaid Guide, available as a multi-volume looseleaf and as an online subscription through Intelliconnect. Lots of information is posted by the Centers for Medicare & Medicaid Services, formerly the Health Care Financing Association (HCFA). Medicare information for consumers is posted on Medicare.gov.

Advisory Opinions:

  1. CMS Advisory Opinions provide guidance for doctors referring patients to an affiliated facility (e.g. a surgicenter). The CMS Advisory Opinions (AOs) provides additional information and the Opinions in PDF format. They are also available in the CCH Medicare and Medicaid Guide (with the "Reports and Other Documents" on Intelliconnect); you can set up a customized Tracker on Intelliconnect to catch them as they come out.

  2. OIG Advisory Opinions concern anti-kickback laws and other "fraud and abuse" issues. The HHS OIG's office provides more information and the Opinions on their Advisory Opinions (AOs) page. They are also available in the CCH Medicare and Medicaid Guide (with the "Reports and Other Documents" on Intelliconnect).

Drug Utilization Review Reports: Each state files a Medicaid Drug Utilization Review (DUR) report with CMS each year. CMS posts the Reports here starting in either 2010 or 2011. You may also be able to find the DUR reports on the website for the relevant state agency.

Fraud: Useful treatises discussing Medicare and Medicaid fraud include Medicare and Medicaid Fraud and Abuse (Thomson/West) and Prosecuting and Defending Health Care Fraud Cases (BNA).

F-Tags: F-Tags (short for "Federal Tags") provide additional guidance on CMS regulations. F-Tags are published in the Appendices to the CMS State Operations Manual (Publication 100-07), available only on the CMS Web site.

Hospital Coverage: Hospital Compare, a joint project of the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services, lets you see how much Medicare paid for procedures at participating hospitals.

Inspector General Reports: Reports by the Department of Health and Human Services - Office of the Inspector General ("HHS-OIG Reports") are posted free back to 1992 on the HHS-OIG Web site. Subscribers can get selected reports back to 1980 by from the CCH Medicare and Medicaid Guide on Intelliconnect.

Settlement Agreements: Medicare- and Medicaid-related Settlement Agreements may be posted on the Web site of the relevant government agency, the local Office of the U.S. Attorney or they may be linked from the docket sheet for a related case. If you can locate the article discussing the settlement in the BNA Health Care Fraud Report or any other BNA publication you can purchase the Agreement from Bloomberg BNA Research & Custom Services (formerly BNA Plus)(800-372-1033, Option 5). If that doesn't work, try calling the government agency or, if you know of a related case, try to locate the document in the case file.


See Also
Doctors
Hospitals
Medical Materials
Pharmaceuticals

For comments, questions and suggestions, email the author
Copyright 2014 Andrew Zimmerman