HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. According to the FBI, more than $43 billion was lost to these scams between June 2016 and December 2021, and in 2021 alone, the FBI Internet Crime Complaint Center received reports of losses of $2,395,953,296 to BEC scams. million, and $6.4

Medicaid 77

Medicaid Medicaid Medicare Medicare 77

Healthcare IT News - Telehealth

DECEMBER 16, 2020

This is according to a new annual report from research and consulting giant PwC entitled “Top health industry issues of 2021: Will a shocked system emerge stronger?” ” Sixty-eight percent of provider executives surveyed by HRI said they plan to use more care navigators and coordinators in 2021.

COVID-19 213

COVID-19 Hospitals Doctors Health Insurance 213

Kaiser Health News

JUNE 29, 2022

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Enrollment more than doubled over the past decade, reaching nearly 27 million people in 2021.

Medicare 102

Medicare Medicare Governance Overpayments 102

Kaiser Health News

APRIL 8, 2022

Prescription drug costs for California’s massive Medicaid program were draining the state budget, so in 2019 Gov. The new Medicaid drug program debuted this January, with a private company in charge. Centene was already a big player in state Medicaid drug programs — but one with a questionable record. SACRAMENTO, Calif.

Medicaid 89

Medicaid Medicaid Health Insurance COVID-19 89

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

Medicaid 52

Medicaid Medicaid ACA Public Health 52

Bill of Health

FEBRUARY 28, 2023

Nicole Huberfeld has long advocated even greater federalization of Medicaid because the traditional cooperative federalism frame serves neither the program beneficiaries nor federalism values well. On September 9, 2021, Executive Order 14043 further required all federal employees to be vaccinated by November 2022.

Public Health 176

Public Health COVID-19 Medicaid Medicaid 176

Bill of Health

JANUARY 23, 2024

for every 100,000 live births in 2021, nearly 33 pregnant people lost their lives. Medicaid pays for more than 40% of births in the U.S., Medicaid pays for more than 40% of births in the U.S., Examining efforts at the federal and state level, I highlight three options, leveraging Medicaid as a policy lever. In the U.S.,

Medicaid 111

Medicaid Medicaid Patient Satisfaction Health Insurance 111

Healthcare IT News - Telehealth

JUNE 3, 2021

HIMSS this week has unveiled the list of the first recipients of its 2021 HIMSS Changemaker Awards. Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services. They are: Aysha Al Mahri. President, Emirates Nursing Association. Abu Dhabi, UAE. Isaiah Nathaniel.

Department of Veterans Affairs 93

Department of Veterans Affairs COVID-19 COVID-19 Vaccine Nurses 93

Bill of Health

MARCH 28, 2023

government had funded the R&D for each of the three patented inventions that are currently blocking generic competition. government has a “paid-up license to practice or have practiced for or on behalf of the United States” the invention “throughout the world” ( 35 U.S.C. As a consequence of this funding, the U.S.

Licensing 261

Licensing Governance Medicare Medicare 261

C&M Health Law

JANUARY 25, 2023

trillion spending package, which consists of all 12 fiscal year (FY) 2023 appropriations bills and funds the federal government through September 30, 2023, provides additional assistance to Ukraine, and makes numerous health care policy changes. 117-164 ) (the “Act”)—an approximately $1.7

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

Bill of Health

SEPTEMBER 29, 2022

In March 2020 , Congress expanded unemployment benefits at unprecedented levels, subsidized businesses, guaranteed paid sick leave for many workers, and broadened Medicaid eligibility. The main motivation behind this campaign was to ensure that the capitalist class would not incur the cost of the pandemic via government intervention.

COVID-19 354

COVID-19 Public Health Federal Policy Medicaid 354

Healthcare Law Blog

AUGUST 3, 2022

is a reminder that the government will use the FCA to target medical device manufacturers for off-label use of medical devices, even where healthcare providers have decided the use is safe and effective. The government is attempting to prove materiality using Medicare’s coverage requirement that procedures must be “reasonable and necessary.”

Governance 52

Governance FDA Medicare Medicare 52

Bill of Health

DECEMBER 6, 2023

To tackle this issue, federal and state governments should strengthen the regulation of insurance networks and insurers should address underlying causes of inadequate networks. The Consolidated Appropriations Act of 2023 requires Medicaid plans to publish and update accurate and searchable provider directories.

Governance 144

Governance Medicaid Medicaid Medicare 144

Hall Render

FEBRUARY 4, 2022

billion from False Claims Act (“FCA”) cases in the federal fiscal year 2021, “the second largest annual total in False Claims Act history” and more than doubling the FCA recoveries for the DOJ from fiscal year 2020. That figure does not include even more funds recovered for state Medicaid programs.

Fraud 40

Fraud Governance Medicare Medicare 40

Healthcare Law Blog

AUGUST 22, 2022

To address this concern, President Biden has asked Congress to implement laws that will empower federal agencies such as the Centers for Medicare and Medicaid Services (CMS) to increase accountability for facility ownership and expand enforcement authority at the ownership level. FOOTNOTES. [1]

Nursing Homes 52

Nursing Homes Nurses Governance Medicare 52

Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. What are the Key Components of a Successful Governance, Risk, and Compliance (GRC) Strategy? Nurs Forum , 56(1):89-94. doi: 10.1111/nuf.12514.

Governance 40

Governance Compliance Hospitals Regulatory Compliance 40

Health Populi

JUNE 3, 2021

But across all priorities, it turns out that prescription drug costs rank higher in Americans’ minds than any other issue in the Kaiser Family Foundation Health Tracking Poll for June 2021. adults said that allowing the federal government and private insurance plans to negotiate for lower prices on Rx drugs was their top priority.

Governance 68

Governance COVID-19 Vaccine COVID-19 Medicare 68

Bill of Health

FEBRUARY 23, 2023

Over the course of the COVID-19 pandemic, now entering its fourth year in 2023, legislators, executives, and judges at every level of government have sought measures to derail efficacious public health interventions. After Florida Governor Ron DeSantis banned school-based mask mandates via executive order in July 2021, affected parents sued.

COVID-19 176

COVID-19 Public Health COVID-19 Vaccine Governance 176

Health Law Advisor

AUGUST 30, 2023

TMA III challenged certain portions of the July 2021 No Surprises Act (“NSA”) interim final rules proposed by the U.S. In a decision that significantly levels the field for providers, the District Court ruled in part for the provider plaintiffs and in part for the Government in the TMA III ruling. Earlier this month, the U.S.

Governance 105

Governance Medicaid Medicaid Medicare 105

Total Medical Compliance Resources

APRIL 14, 2023

FACT SHEET: Biden-Harris Administration Makes Progress in the Whole-of-Government Response to Long COVID U.S. Diagnosis code education: The Centers for Medicare and Medicaid developed educational materials for providers so they can use the new ICD-10 code for Long COVID. Agencies across the U.S.

Governance 59

Governance COVID-19 Department of Veterans Affairs COVID-19 Vaccine 59

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

HIT Consultant

SEPTEMBER 12, 2022

– Using Gainwell’s advanced research platform and de-identified Medicaid claims data from select clients, Stanford concluded that 30 percent of patients prescribed opioids for the first time developed a dependency. Stanford used 180,000 de-identified Medicaid claims from six states. According to the U.S.

Medicaid 95

Medicaid Medicaid Health Outcomes Governance 95

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. d)(6)), which are effective July 1, 2021.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Healthcare IT News - Telehealth

FEBRUARY 21, 2023

The division's previous school-based telehealth project pilots with the Switzerland of Ohio School District in Monroe County in 2020 and multiple districts in the Muskingum Valley Educational Service Center in 2021 provided nearly 22,000 students with telehealth services. THE LARGER TREND Broadband and telehealth access go hand in hand.

Governance 130

Governance Medicaid Medicaid Public Health 130

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. The higher the ratings, the larger the bonus payments health plans receive from the government. New CMS star ratings criteria 2021. Centers for Medicare & Medicaid.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

C&M Health Law

FEBRUARY 6, 2023

Both cases were filed by manufacturers after the government sent letters stating that manufacturers had violated the 340B program by restricting the delivery of drugs to a covered entity’s contract pharmacies. 16, 2022), and the government prevailed in Sanofi-Aventis U.S., 16, 2022), and the government prevailed in Sanofi-Aventis U.S.,

Medicaid 52

Medicaid Medicaid Governance 52

Health Populi

JUNE 18, 2021

Even in 2021, we still see so-called “job-lock” with workers staying in jobs that offer health insurance benefits. adults aged 18 and over in March 2021 for this study. Compared with people enrolled in Medicaid, members of private insurance plans were more likely to have medical debt. California v. One-half of U.S.

ACA 133

ACA Health Insurance Medicaid Medicaid 133

HIT Consultant

JULY 17, 2023

The CDC reported 100,306 drug overdose deaths in the US in the 12 months ending in April 2021, the highest number ever recorded in 12 months and a staggering 28.5% Cessation of PHE telehealth, prescribing, and mental health access exceptions could impact the Medicaid population the most. increase from the previous year.

Public Health 97

Public Health Medicaid Medicaid Electronic Medical Records 97

HIT Consultant

JANUARY 23, 2023

What You Should Know: – Healthcare profit pools are expected to grow 4 percent annually resulting from $654 billion in 2021 to $790 billion in 2026 , according to a new McKinsey report. Previously, in July 2022, it was estimated that provider profit pools would grow at a 7 percent CAGR from 2021 to 2025.

COVID-19 52

COVID-19 Medicaid Medicaid Public Health 52

Bill of Health

MARCH 15, 2022

Further, safety net programs, such as Medicaid and Supplemental Security Income (SSI), have stringent rules that prevent people with disabilities from working while simultaneously forcing them to live in poverty. However, expanding safety net programs , such as SSI and Medicaid, would be important as an interim measure.

COVID-19 246

COVID-19 ADA Medicaid Medicaid 246

HIT Consultant

AUGUST 5, 2022

– Healthcare & Life Science M&A activity plummeted to 338 deals in Q2 2022 versus 535 in Q2 2021 and a record 565 deals in Q4 2021. In California, Medicaid has become an attractive and lucrative business for providers who know how to effectively operate in the segment. .

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 98

Kaiser Health News

DECEMBER 23, 2021

President Joe Biden’s top health advisers credited the increased government subsidies, which lowered out-of-pocket costs, for the surge in enrollment. Some of the largest increases are in Florida, Texas, Georgia and nine other states that have not expanded Medicaid under the Affordable Care Act. ” The 13.6

Health Insurance 93

Health Insurance ACA Medicaid Medicaid 93

Kaiser Health News

NOVEMBER 27, 2023

Earlier this year, DeSantis blasted California for being too generous with public benefit programs, such as Medicaid, which the Golden State has expanded to all eligible residents regardless of immigration status. Obamacare Florida DeSantis has refused to expand Medicaid eligibility to more people under the Affordable Care Act.

COVID-19 Vaccine 99

COVID-19 Vaccine COVID-19 Medicaid Medicaid 99

HIT Consultant

MARCH 8, 2022

Under the PHE, states must keep Medicaid enrollees continuously covered, irrespective of their circumstances. . By December 2021, enrollment in Medicaid and CHIP (Children’s Health Insurance Program) grew to a record high of more than 83 million individuals, primarily due to the continuous coverage requirements of the PHE.

Public Health 98

Public Health Medicaid Medicaid Health Insurance 98

Compliance Now

DECEMBER 28, 2022

The guidance establishes limited deadline and enforcement relief for the 2020 and 2021 Prescription Drug Data Collection (RxDC) submissions that were due by December 27, 2022. This deadline and enforcement relief is transitional and only applies to the 2020 and 2021 calendar year submissions that were originally due on December 27, 2022.

Health Insurance 100

Health Insurance Compliance Medicaid Medicaid 100

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 Over $5 billion of the total amount recovered in 2021 was related to the healthcare industry. Abuse of government healthcare programs is a federal offense with severe penalties.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIT Consultant

JUNE 7, 2023

In 2016, the Golden State began its Whole-Person Care (WPC) pilots at the county level integrating physical health, behavioral health, and social services for complex needs Medicaid enrollees. billion (about $42 per person in the US) per year after paying for the cost of food with most savings occurring within Medicare and Medicaid.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52