Medicare and Medicaid Law




Medicare is part of the Federal Government's Social Security Division and provides all United States citizens 65 years of age or older with long term care as well as coverage for the disabled. Eligibility is determined by various criteria set forth in the programs' policies. Whereas Medicaid, a federal and state program, ensures that individuals with lower incomes have access to health care. The criteria for Eligibility varies from state to state.

State Medicaid Plan

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Articles on HG.org Related to Medicare and Medicaid Law

  • Former CEO Alleges Stark Law Violations
    An Oregon-based health care group allegedly fired and then blacklisted its former CEO in retaliation for his reporting of improper payments and referrals under the False Claims Act and Stark Law, according to a recently filed complaint.
  • Steep Penalties for HIPAA Violations
    Doctors, nurses and other healthcare practitioners have access to highly confidential information regarding patients’ health and medical history.
  • Updates to the Stark Law
    The United States Department of Health and Human Services (DHHS) has published updates to Section 1877 of the Social Security Act, commonly referred to as the Stark Law.
  • Concierge Medical Practices
    You know the story. As Medicare spins out of control, many doctors turn to concierge medicine. Concierge medical practices offer primary care, on a fixed monthly or annual fee, to a limited number of patients (e.g. 300 to 800 patients). In this article, I discuss two legal issues for a concierge practice –Medicare, and the basic terms of the patient contract.
  • Medicaid Fraud Investigations in New York
    A Medicaid fraud investigation begins long before you are contacted by an investigator. By the time they contact you, the investigators have already conducted interviews and collected all the records they need. At this point, anything you say can and will be used against you.
  • Understanding Medicaid Fraud Investigations in New York City
    A Medicaid fraud investigation is a serious matter that can lead to criminal charges. You should consult with a Medicaid fraud lawyer before you speak with investigators or turn over any documents.
  • $75,000 Whistleblower Reward in EMR Kickback Case
    Diagnostic Pathology Group Pays $500,000 to Settle Allegations that Physicians Were Given Electronic Medical Record (EMR) Software in Exchange for Patient Referrals
  • Responding to NYC Medicaid Fraud Investigations
    If you receive a letter from the NYC Bureau of Fraud Investigation, it means that you are the target of a Medicaid fraud investigation. How you respond to the letter can mean the difference between an inconvenience and a criminal record.
  • NYC Bureau of Fraud Investigation Letters
    A letter from the NYC Bureau of Fraud Investigation means that you have a potentially serious problem. Do not try to handle this on your own. Consult with an experienced Medicaid fraud lawyer before you meet with the investigators.
  • Statute Could Have Chilling Effect
    Section 1877 of the Social Security Act, also known as the “Stark Law” (42 U.S.C. § 1395nn), has been expanded and amended on several occasions by Congress since its original enactment in 1989.
  • All Health Care and Social Law Articles

    Articles written by attorneys and experts worldwide discussing legal aspects related to Health Care and Social including: defective drugs, failure to diagnose, informed consent, medical law, medical malpractice, medication errors, pharmaceutical law, social security, social services law, surgical errors.

Medicare and Medicaid Law - US

  • Affordable Care Act

    On March 23, 2010, President Obama signed into law the Affordable Care Act. The law puts into place comprehensive health insurance reforms that will hold insurance companies more accountable and will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

  • Center for Medicare and Medicaid Services

    The Centers for Medicare and Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency that administers the Medicare program and monitors the Medicaid programs offered by each state.

  • Conditions of Participation (CoPs) and Conditions for Coverage (CfCs)

    CMS develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These minimum health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries. CMS also ensures that the standards of accrediting organizations recognized by CMS (through a process called "deeming") meet or exceed the Medicare standards set forth in the CoPs / CfCs.

  • Department of Health and Human Services (HHS)

    The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

  • Medicaid - Overview

    Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy – and stay healthy. Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.

  • Medicaid Insurance - Wikipedia

    Medicaid is the United States health program for eligible individuals and families with low incomes and resources. It is a means tested program that is jointly funded by the state and federal governments, and is managed by the states.[1] Among the groups of people served by Medicaid are certain eligible U.S. citizens and resident aliens, including low-income adults and their children, and people with certain disabilities. Poverty alone does not necessarily qualify an individual for Medicaid. Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States.

  • Medicare Insurance - Wikipedia

    Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. The program also funds residency training programs for the vast majority of physicians in the United States. Medicare operates as a single-payer health care system.

  • My Medicare - United States Government

    MyMedicare.gov is part of the Medicare.gov web site. MyMedicare.gov is an optional, free, and secure site designed to help you check the status of your eligibility, enrollment, and other Medicare benefits. It also allows you to access your claims information almost immediately after it is processed by Medicare and provides you with preventive health information 24 hours a day, seven days a week.

  • Patient Protection and Affordable Care Act

    This is the major health care reform bill, signed into law by President Obama on March 23, 2010. It would expand health care coverage to 31 million currently uninsured Americans through a combination of cost controls, subsidies and mandates. It is estimated to cost $848 billion over a 10 year period, but would be fully offset by new taxes and revenues and would actually reduce the deficit by $131 billion over the same period.

  • Social Security Administration

    We deliver services through a nationwide network of over 1,400 offices that include regional offices, field offices, card centers, teleservice centers, processing centers, hearing offices, the Appeals Council, and our State and territorial partners, the Disability Determination Services. We also have a presence in U.S. embassies around the globe. For the public, we are the “face of the government.” The rich diversity of our employees mirrors the public we serve.

  • Social Security Law - Medicare

    Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.

Organizations Related to Medicare and Medicaid Law

  • American Seniors Association

    Known nationally as "the conservative alternative to the AARP," the American Seniors Association works hard to fulfill its mission to provide seniors with the choices, information, and services they need to live healthier, wealthier lives. Our members' dignity and security matter most to us, and that's why thousands of Americans every year turn to the American Seniors Association for the help they need.

  • Caregivers Action Network

    The National Family Caregivers Association educates, supports, empowers and speaks up for the more than 65 million Americans who care for loved ones with a chronic illness or disability or the frailties of old age. NFCA reaches across the boundaries of diagnoses, relationships and life stages to help transform family caregivers' lives by removing barriers to health and well being.

  • National Association of State Medicaid Directors (NASMD)

    The National Association of State Medicaid Directors (NASMD) is a bipartisan, professional, nonprofit organization of representatives of state Medicaid agencies (including the District of Columbia and the territories). Since 1979, NASMD has been affiliated with the American Public Human Services Association (APHSA). The primary purposes of NASMD are: to serve as a focal point of communication between the states and the federal government, and to provide an information network among the states on issues pertinent to the Medicaid program.




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