HIPAA Journal

JULY 31, 2023

a government services contracting company, has announced in a Securities and Exchange Commission (SEC) filing that hackers exploited a zero-day vulnerability in Progress Software’s MOVEit Transfer solution in May 2023 and accessed the protected health information (PHI) of between 8 and 11 million individuals.

Governance 70

Governance Medicare Medicare Ransomware 70

Healthcare IT News - Telehealth

JANUARY 23, 2023

We spoke with the HIMSS government relations team for their thoughts on those priorities and more in 2023 and beyond. Budget leaders have asked, "How do you really know what the impact on the Medicare population and the Medicare Trust Fund will be? Creating standards synergy for 'Interoperability 3.0'

Medicare 150

Medicare Medicare Governance Medicaid 150

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Enrollee Participation in Plan Governance (§ 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Bill of Health

MAY 22, 2023

The selections feature topics ranging from an analysis of government and industry investments for recently approved drugs, to a discussion of court decisions on mifepristone, and an examination of the added therapeutic benefit associated with the top-selling brand-name drugs in Medicare. 2023 Apr 7;4(4):e230511. 2023 Apr 26.

Pharmaceutical Industry 157

Pharmaceutical Industry Medicare Medicare Medicaid 157

Healthcare IT News - Telehealth

DECEMBER 5, 2022

Dan Brillman, CEO of Unite Us, and Melissa Sherry, vice president of social care integration at Unite Us, offer Healthcare IT News readers insights into how these and other challenges are likely to be handled in 2023. At the same time, we are seeing state Medicaid programs taking novel approaches to tackling issues of health equity.

US Department of Health and Human Services 175

US Department of Health and Human Services Medicaid Medicaid Department of Veterans Affairs 175

The Health Law Firm Blog

FEBRUARY 8, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency.

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Nurses Medicaid Medicaid Medicare 40

The Health Law Firm Blog

JANUARY 18, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 80

Medicaid Medicaid Ransomware Health Insurance 80

Bill of Health

MARCH 28, 2023

By James Love On March 21, 2023, the NIH, acting on behalf of HHS Secretary Xavier Becerra, rejected a petition from four cancer patients asking HHS to use the government’s rights in the prostate cancer drug enzalutamide, in order to remedy pricing abuses by the patent holder. The abuse is charging U.S. The statute, 35 U.S.C.

Licensing 261

Licensing Governance Medicare Medicare 261

HIT Consultant

NOVEMBER 9, 2023

Director of Healthcare Strategy, LexisNexis Risk Solutions During the peak of the Covid-19 pandemic, over 10 million Americans enrolled in Medicaid – nearly a 14% increase from the beginning of 2020. A month before the public health emergency ended on May 11, 2023, 87 million individuals were enrolled in Medicaid.

Medicaid 64

Medicaid Medicaid Health Insurance Health Outcomes 64

Hall Render

FEBRUARY 21, 2023

For SNFs, the data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). For NFs, the data would be reported via means prescribed by the particular state Medicaid agency. Comments on the proposed rule may be submitted until April 14, 2023.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Health Law Advisor

NOVEMBER 2, 2022

Announced in the Consolidated Appropriations Act of 2021, Rural Emergency Hospitals (REHs) will be a new type of Medicare provider starting January 1, 2023. This monthly facility payment will increase after CY 2023 at the hospital market basket percentage increase.

Medicare 52

Medicare Medicare Hospitals Malpractice 52

Healthcare Law Blog

AUGUST 25, 2023

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.

Overpayments 52

Overpayments Overpayment Medicaid Medicaid 52

Total Medical ComplianceHIPAA

NOVEMBER 13, 2023

They are: Health IT developers of certified health IT Entities offering certified health IT Health information exchanges Health information networks These penalties began on September 1, 2023, and OIG will not be imposing penalties for any blocking conduct that happened prior to that date.

HIPAA 52

HIPAA Medicaid Medicaid Medicare 52

HIT Consultant

JANUARY 18, 2023

Community pharmacists trusted to deliver care: In 2023, pharmacists will play an integral role as part of the team managing patient care for diseases like diabetes, hypertension, or multiple comorbidities. In 2022, 135 new bills that impacted PBM business practices were introduced in 36 states and many will continue to be in review in 2023.

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Compliance Medicaid Medicaid Medicare 98

Kaiser Health News

AUGUST 12, 2022

First, it would give the federal government the ability to negotiate prices of some drugs purchased by Medicare beneficiaries, a tool that has long been opposed by the drug industry. The drug pricing provision, estimated to save the government nearly $100 billion over 10 years, would require the U.S. “It’s historic.

Medicare 89

Medicare Medicare Prescription Drug Pricing Governance 89

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. Led by acting Inspector General Christi A.

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

HIPAA Journal

AUGUST 21, 2023

The figures this month bring the running breach total for 2023 up to 395 incidents, across which the records of 59,569,604 individuals have been exposed or stolen. The average breach size for 2023 is 150,809 records and the median breach size is 4,209 records. Over the past 12 months, more than 81.76 million and 47.6

Ransomware 79

Ransomware HIPAA Medicare Medicare 79

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

C&M Health Law

DECEMBER 13, 2022

In 2023, we expect to see health care policy developments in the following key domains: reproductive rights and gender discrimination, health data privacy, telehealth, and price transparency. . part 2 (“Part 2”) governing the confidentiality of substance use disorder records. Price Transparency .

COVID-19 98

COVID-19 Medicare Medicare Hospitals 98

HIT Consultant

JANUARY 23, 2023

– Avalere’s ‘2023 Healthcare Industry Outlook’ examines how community-wide healthcare will be affected by a recent court ruling, and consider data’s role in addressing health disparities. Key Trends in Healthcare in 2023 The main insights from the report are highlighted as follows: 1.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-421325, 2023 CPD ¶ 74 (Mar.

Governance 52

Governance Department of Veterans Affairs Medicaid Medicaid 52

Health Care Law Brief

FEBRUARY 2, 2023

After multiple extensions over the past three years, on Monday, January 30, 2023, President Biden announced that the COVID-19 national emergency and public health emergency (“ PHE ”) will officially end on May 11, 2023. higher payment) through December 31, 2023.

COVID-19 98

COVID-19 Medicare Medicare Medicaid 98

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”).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Kaiser Health News

DECEMBER 1, 2022

Meanwhile, some of the remaining states that have not yet expanded the Medicaid program may be warming up to the idea, particularly North Carolina and Kansas, which have Democratic governors and Republican legislatures. Meanwhile, governments and social media platforms are still struggling to address covid misinformation and disinformation.

Medicaid 62

Medicaid Medicaid COVID-19 FDA 62

HIPAA Journal

APRIL 29, 2024

Berry, Dunn, McNeil & Parker, LLC (BerryDunn) provides health data analytics services to healthcare providers, health insurers, and government regulatory and healthcare policy agencies and its clients provide BerryDunn with personal and health data to allow the firm to perform its contracted services.

Health Insurance 95

Health Insurance Health Analytics HIPAA Medicaid 95

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. This year, 50% of Medicare enrollees are expected to sign up for Medicare Advantage.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. The Final Rule went into effect on June 5, 2023, and can be found here.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

Jackson Lewis

JUNE 21, 2023

22-111 (June 1, 2023). Following the Court’s decision, Medicare and Medicaid providers and other federal contractors should practice caution when submitting claims to the U.S. government. SuperValu Inc. , 21-1326, together with U.S. Safeway, Inc. , Read more.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Medisys Compliance

MAY 5, 2022

On 22 nd April 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52

HIT Consultant

APRIL 4, 2023

What You Should Know: 2023 started off with the hallmarks of a rebound year. Q1 Funding Soars, But 2023 May Struggle to Catch Up to 2019 Q1 2023 U.S. If funding for the next three quarters matches the average funding across the prior three quarters, 2023 is on pace for the lowest level of annual funding since 2019.

FDA 52

FDA Medicaid Medicaid COVID-19 52

Health Law Advisor

AUGUST 14, 2023

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

Health Law Advisor

AUGUST 30, 2023

On August 24, 2023, 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. The Centers for Medicare & Medicaid Services (“CMS”) responded to the ruling by temporarily suspending all Federal (i.e.,

Governance 105

Governance Medicaid Medicaid Medicare 105