';
CLOSE
Authors Posts by Tim Sohosky

Tim Sohosky

111 POSTS 0 COMMENTS

0 731
Hole torn in a dollar bill with medicaid text

The U.S. House Energy and Commerce Committee recently sent a letter to Governor Josh Shapiro and DHS Secretary Valerie Arkoosh requesting information about fraud, waste, and abuse prevention in Pennsylvania’s Medicaid program. The request is part of a broader federal oversight effort examining Medicaid program integrity following recent fraud investigations in multiple states. Similar letters were also sent to officials in ME, NE, NY, OR, WA, VT, CO, CA, and MA.

The Committee is seeking details on Pennsylvania’s fraud prevention efforts, including audits, provider screening processes, improper payment recovery, enforcement actions, and oversight of Medicaid programs, such as Home and Community-Based Services.

The letter references several recent Medicaid fraud prosecutions in Pennsylvania. However, it also highlights that Pennsylvania’s Medicaid Fraud Control Section charged more fraud cases than any other state in FY 2024 and ranked third nationally in criminal convictions. The fact that these cases were identified and prosecuted demonstrates that Pennsylvania’s fraud, waste, and abuse prevention systems are actively working to detect and address wrongdoing.

RCPA recognizes that this new federal focus on Medicaid program integrity may intersect with our ongoing advocacy to eliminate the requirement for signed encounter forms in Medicaid-funded services. RCPA has long maintained that the current requirement is administratively burdensome and does not meaningfully strengthen program integrity compared to other documentation and verification mechanisms already in place. While our advocacy continues, increased federal scrutiny around fraud prevention may influence how state and federal policymakers evaluate documentation and verification requirements moving forward.

The Pennsylvania Department of Human Services must submit responses to the Committee by March 17, 2026. RCPA will continue to monitor developments and provide updates as appropriate.

0 897

The U.S. Department of Labor’s (DOL) Wage and Hour Division (WHD) published a proposed rule concerning the process and criteria used to determine a worker’s classification as an employee or an independent contractor under the Fair Labor Standards Act and related federal laws.

This proposed rule would rescind DOL’s 2024 Final Rule addressing the classification of independent contractors and replace it with an analysis for employee classification similar to the one adopted by DOL in 2021. The classification analysis in the proposed rule would:

  • Apply an “economic reality” test to determine whether a worker is in business for himself or herself as an independent contractor or is an employee economically dependent on an employer for work;
  • Identify and explain two “core factors” to help determine if a worker is economically dependent on an employer for work or in business for him- or herself:
    • The nature and degree of control over the work; and
    • The worker’s opportunity for profit or loss based on initiative and/or investment;
  • Identify other factors to help determine a worker’s status as an employee or independent contractor, including the amount of skill required for the work, degree of permanence of the working relationship, and whether the work is part of an integrated unit of production;
  • Advise that the actual practice of the worker and the potential employer is more relevant than what may be contractually or theoretically possible; and
  • Provide eight fact-specific examples applying the factors to real-life circumstances.

Last year, DOL published guidance advising WHD field staff on the analysis to apply when determining employee or independent contractor status. That guidance instructed agency investigators to stop applying the analysis from DOL’s 2024 rule in current enforcement matters but, instead, rely on the principles outlined in Field Assistance Bulletin No. 2025-1 and Fact Sheet #13.

The 2024 final rule prompted a number of federal lawsuits challenging its legality. As a result, DOL said last year that it would be “…reconsidering the 2024 Rule, including whether to rescind the regulation.”

DOL will be accepting comments on this proposed rule through 11:59 pm (ET) April 28, 2026.

0 1373

Message from the PA Department of Human Services (DHS):

Under the current federal administration, the U.S. Department of Homeland Security (U.S. DHS) has lifted restrictions that previously prohibited Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) officers from carrying out immigration enforcement actions, including arrests, in protected areas such as medical and behavioral health care facilities and social services establishments. It is now possible that U.S. DHS may attempt to conduct immigration enforcement activities in these settings.

The Pennsylvania Department of Human Services, along with the departments of Aging, Drug and Alcohol Programs, and Health, has prepared a non-regulatory advisory to provide general information about federal law applicable to immigration enforcement activities at health care and social services facilities. We also advise facility leadership and counsel to develop a written policy and standard operating procedures for what to do if immigration enforcement agents arrive on facility property or seek information about individuals you serve for immigration enforcement reasons.

In developing these policies and procedures, the Pennsylvania Department of Human Services advises that you consider:

  • Designating legal and administrative point person(s) by name and phone number who will interact with immigration agents and review legal documents;
  • Planning for how your facility will respond to requests for information, requests to enter non-public spaces to conduct an arrest, and immigration enforcement activity in public spaces;
  • Engaging in advance with stakeholders and necessary resources; and
  • Minimizing disruption to individuals served.

This advisory does not provide legal advice. Consult a licensed attorney or accredited representative for legal questions about a specific situation.

Thank you for your service to Pennsylvania.

0 223

ODP Residential Providers are reminded that the ODP MyPBC Portal is now open for providers to submit their Performance-Based Contracting (PBC) data. The portal will remain open for providers to submit their data until March 16, 2026, at 11:59 pm.

ODP held a training for the MyPBC Portal system for Residential Service Providers. The recording of this session can be found here.

Please view ODPANN 26-017 for more details.

123...12Next Page 1 of 12
© 2021 - Rehabilitation & Community Providers Association