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Planned Parenthood Pays $4.3 Million to Settle Allegations of Medicaid Fraud in Qui Tam/Whistleblower Case

The Health Law Firm

The nonprofit organization is accused of fraudulently billing Medicaid and other government programs for health services provided by some of its Texas clinics between 2003 and 2009, according to the DOJ. Indest III, J.D., Board Certified by The Florida Bar in Health Law Planned Parenthood Gulf Coast recently paid $4.3

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Proper Payments for Part B and Part D Drugs

Innovaare Compliance

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

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Sentencing Guidelines: Third Circuit Rejects Use of “Intended” Loss in Favor of “Actual” Loss

Healthcare Law Today

Payers, such as Medicare and Medicaid, commonly pay only a fraction of any billed amount, depending upon factors such as fee schedules, deductibles, co-pays, and other adjustments to payable amounts. 2 However in those cases, the actual loss is almost always far less. Melgen , 967 F. 3d 1250, 1265-66 (11th Cir. Miller , 316 F.3d

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Why a Focus on Behavioral Health is Key to Improving Quality Measures

HIT Consultant

Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. Analysts looked at the health care costs of individuals enrolled in commercial insurance, Medicare, and Medicaid in the United States.

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Physicians Beware! Groups Providing DME, Prosthetic Devices, and Other Medical Supplies to Their Medicare Patients Risk Violating the Strict Liability Stark Law Since the Expiration of COVID-19 Public Health Emergency

Health Law Advisor

2] Centers for Medicare & Medicaid Services, Spotlight: Physician-Owned Hospital Expansion Exception Requests – Changes Effective October 1, 2023 , available at [link] (last accessed August 2, 2023). [3] 9] See OIG Special Advisory Bulletin on Contractual Joint Ventures, April 2003, available at [link] (last accessed Aug.

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In U.S. Health Care, It’s Still the Prices, Stupid – But Transparency and Consumer Behavior Aren’t Working As Planned

Health Populi

back in 2003 — so we’ve known for over 16 years that in the U.S., From 2003 to 2019, the theory that prices are the primary driver of America’s spending more on health care than any other country is still the case. And see here on JD Supra for more details on the rules.

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3 Ways Artificial Intelligence Can be Used to Improve Health Equity

HIT Consultant

Medicare and Medicaid have an obligation to taxpayers who are paying into the system to help as many people as possible. John co-founded BroadReach Group in 2003 and currently serves on the Board of Managers. Healthcare inequities are also a drag on our economic systems.

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