Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. The woman, 45, pleaded guilty to an amended charge of Reckless Conduct (Class A Misdemeanor).

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CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

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Pharmacy Law Blog

MARCH 13, 2018

On December 4, 2017, a Florida federal judge refused to dismiss the federal government’s False Claims Act (FCA) suit against a compounding pharmacy. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. December 4, 2017). fraud suit – judge.”

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Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

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Provider Trust

JULY 17, 2023

To combat this fraud, waste, and abuse, the OIG introduced a three-part plan called the PRO framework to guide the oversight of nursing homes. This can help organizations better understand areas like the reporting of related party costs and how nursing homes use Medicaid funding to provide care.

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Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate. He is awaiting sentencing on those charges.

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Hall Render

MAY 10, 2024

Vincent reopens Westside Crossing Walk-In Care Indiana’s 2017 abortion law violates free speech, federal judge rules Ind. Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

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Med Law Blog

MAY 1, 2023

Additional Investigative and Enforcement Activity In 2017, a whistleblower suit was filed against Surgery Partners, Inc. Hahnemann Hospital and St. Christopher’s Hospital, to American Academic Health System, which then closed Hahnemann Hospital in June of 2019. in United States ex rel. Cho and Baker v. Surgery Partners, Inc.

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Health Law RX

NOVEMBER 10, 2022

The United States alleged that, between August 1, 2016 and June 30, 2017, Sutter Health fraudulently billed and received reimbursement from government health programs for lab tests that Sutter Health did not itself perform.

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Governance Medicare Medicare Medicaid 52

Pharmacy Law Blog

MARCH 8, 2018

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” They face maximum sentences of 10 years in prison on the health care fraud counts. December 5, 2017). December 5, 2017). By George F. Indest III, J.D.,

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Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts (§ 422.107).

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CMS.gov

NOVEMBER 16, 2018

Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. percent in 2017 to 8.12

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Verisys

MARCH 24, 2022

Healthcare facilities receive billions of dollars in federal and state funding through the Affordable Care Act (ACA), Medicare, Medicaid, CHIP, and other programs. A 2017 report showed several of the largest penalties have been imposed on small- to medium-sized healthcare organizations, including United Medical Instruments Inc.

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AIHC

AUGUST 8, 2023

I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA). In an October 12, 2017 article over Dr. Deming I find the best characterization of him and his importance to Quality.

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Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. 7,872 2018 5,851 77.1% 7,589 2019 5,871 79.3% 7,215 2021 5,532 77.5%

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AIHC

FEBRUARY 16, 2024

Because aspiration pneumonia is excluded from Centers for Medical & Medicaid Services (CMS) pneumonia mortality scores, the implicit conclusion is that a hospital can improve its public rating by coding its oldest and sickest patients with pneumonia as having aspiration pneumonia. First, we need to look at exactly what happened.

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Because aspiration pneumonia is excluded from Centers for Medical & Medicaid Services (CMS) pneumonia mortality scores, the implicit conclusion is that a hospital can improve its public rating by coding its oldest and sickest patients with pneumonia as having aspiration pneumonia. First, we need to look at exactly what happened.

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Healthcare IT Today

MARCH 26, 2023

Researchers detected behavior consistent with fraud and abuse by identifying excess expenditures in hospitalization claims from 2017 and validated their methods based on Department of Justice data. Partnerships Castle Connolly Top Doctors has integrated ZocDoc ‘s appointment booking features into select doctors’ profiles.

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New Jersey Healthcare Blog

JULY 22, 2022

The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. On April 4, 2022, at 54 N.J.R. 620(b), the Department of Human Services, Division of Medical Assistance and Health Services adopted amendments to Transportation Services Rules. See N.J.A.C. 191 (N.J.S.A.

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Hall Render

FEBRUARY 24, 2023

Dunleavy adds $9M to budget to address food stamp, Medicaid backlog New study provides snapshot of increase in maternal deaths in Alaska Mental Health Trust Grants $1.6M Dunleavy adds $9M to budget to address food stamp, Medicaid backlog New study provides snapshot of increase in maternal deaths in Alaska Mental Health Trust Grants $1.6M

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CMS.gov

DECEMBER 21, 2018

Administrator, Centers for Medicare & Medicaid Services. CMS issues waivers to ACOs of specific fraud and abuse laws in order to provide the regulatory relief needed to innovate, including waivers of provisions of the Stark Law and the Federal Anti-Kickback Statute. “Pathways to Success,” an Overhaul of Medicare’s ACO Program.

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Medicare Medicare Payment Systems Fraud 41

Hall Render

APRIL 21, 2023

health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C.

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US Department of Health and Human Services COVID-19 Nurses Nursing Homes 40

Hall Render

JANUARY 14, 2022

New Arkansas Law Raises Medicaid Prescription Cap. Medicaid, Medicare won’t pay Denver-area elder care provider for new clients after finding staffing issues, other problems. Florida hospitals face severe staffing shortage ‘crisis’ Florida medical supply company to pay $600K in Medicare fraud settlement. NEW MEXICO.

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Hall Render

JANUARY 28, 2022

Arkansas health officials ask state for $400M to cover increased Medicaid costs. Federal officials arrest nursing home owner charged with more than $3M in Arkansas Medicaid fraud. More Civil, Criminal Charges for Former Skyline CEO Accused of Tax and Medicaid Fraud. Judge to rule soon on Ga.

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CMS.gov

NOVEMBER 2, 2018

Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare has a plethora of misaligned financial incentives that work to increase costs for taxpayers and beneficiaries, and create challenges related to fraud and abuse. CMS BLOG: Medicare for All? Just another name for a government-run, single payer system.

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