Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. public in overpayments.

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Overpayments Overpayment COVID-19 Medicare 95

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

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Overpayments Overpayment ACA Medicare 52

Healthcare Law Blog

FEBRUARY 9, 2024

Following the resolution of this case, hospitals are encouraged to revisit their arrangements with private physician groups to ensure that proper safeguards are in place to mitigate FCA risk. Hospitals may also want audit rights to ensure that it has the ability to monitor billing compliance by private physicians on a regular basis.

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Hospitals Compliance Officers Compliance Overpayments 52

Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

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Medicaid Medicaid Compliance Overpayments 52

Healthcare IT News - Telehealth

JUNE 8, 2022

But even now, hospitals and health systems should be preparing proactively to meet the regulatory demands of a post-PHE future. State government executive orders. Additionally, any reimbursement resulting from these claims could be considered an overpayment. Providers have been promised at least 60 days' notice.

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US Department of Health and Human Services Compliance Overpayments Overpayment 182

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

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Fraud Overpayments Overpayment Governance 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

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US Department of Health and Human Services Compliance Officers Compliance Fraud 52