Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

The Health Law Firm

OCTOBER 18, 2012

Law Clerk, The Health Law Firm On August 9, 2012, the United States Court of Appeals for the Fifth Circuit, located in New Orleans, Louisianna, affirmed the conviction of a patient recruiter in Texas for Medicare Fraud committed after Hurricane Katrina. The patient recruiter was charged with conspiracy to defraud Medicare.

Fraud 40

Fraud Medicare Medicare 40

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients. By George F. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare Governance 40

CMS.gov

SEPTEMBER 22, 2020

Want to know the percentage of people who have a Medicare Advantage plan compared to all people with Medicare in Maryland from 2007 to 2011? You can find answers to these types of questions using the newly launched Medicare Enrollment Dashboard and Part B Physician/Supplier Dashboard.

Medicare 20

Medicare Medicare 20

Jane Sarashon

FEBRUARY 28, 2022

I started the Health Populi blog in September 2007 with a post titled “Health Care is the #1 Line Item in Our National Economy… and Taking More Out of Your Pocket,” displaying this sign from Tom’s Shell gas station comparing the price of gas to an “Arm, Leg, or your First Born” posted on their sign in 2007.

COVID-19 56

COVID-19 Health Insurance Medicaid Medicaid 56

Health Law RX

JUNE 2, 2023

The Court’s Supervalu Decision Supervalu involved two combined FCA cases, both brought against supermarkets (Supervalu and Safeway) that house internal pharmacies and that participate with Medicare and Medicaid. [6] per 30-day supply). [9] per 30-day supply). [10] 12] The Court unanimously disagreed. per 30-day supply). [9] SuperValu Inc. ,

Fraud 52

Fraud Governance Medicaid Medicaid 52

Health Populi

JUNE 13, 2018

Here is the first “good news” line chart, showing declining medical trend from 2007 to next year in 2019. That’s one-half the high point at nearly 12% in 2007. As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S.

Medicaid 63

Medicaid Medicaid Health Insurance Medicare 63

Health Care Law Brief

JUNE 20, 2023

The District and the Seventh Circuit Endorsed a Pure Objective Reasonableness Standard for FCA Scienter In this case, the relator alleged that certain pharmacies, among other things, misreported their pricing of certain drugs covered by Medicare and Medicaid. See Safeco Ins. of America v. Burr , 551 U.S.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

The Health Law Firm

OCTOBER 2, 2013

The providers were accused of fraudulently billing Medicare and TRICARE from 2007 until 2010. Indest III, J.D., Board Certified by The Florida Bar in Health Law A federal whistleblower or qui tam lawsuit against a local physician group has been settled, according to the Orlando Business Journal (OBJ) on September 30, 2013.

Medicare 40

Medicare Medicare 40

The Health Law Firm

SEPTEMBER 23, 2013

The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. Indest III, J.D., Board Certified by The Florida Bar in Health Law A group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5

Fraud 40

Fraud Medicaid Medicaid Medicare 40

The Health Law Firm

OCTOBER 9, 2012

In September 2012, the Centers for Medicare and Medicaid Services (CMS) made the decision to allow Recovery Audit Contractors (RACs) to begin reviewing the billing codes for office visits for healthcare providers. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law. Connolly, Inc.,

Medicaid 40

Medicaid Medicaid Doctors Medicare 40

Health Populi

OCTOBER 28, 2019

published by the National Bureau of Economic Research found a close link between electoral politics and Medicare: that is, between legislative processes in the U.S. Between 2007 and 2014, hospital prices grew 42%. A recent study on politics and health care spending in the U.S. Congress and healthcare spending.

Hospitals 54

Hospitals Prescription Drug Pricing Pharmaceutical Industry Medical Billing 54

Hall Render

APRIL 6, 2022

The relator alleged that these programs and subsequent reporting of the retail price, and not the discounted price, violated Medicare Part D’s requirement that a pharmacy must report the usual and customary price charged for the drugs. SuperValu Inc., of America v. Burr was applicable to lawsuits brought under the False Claims Act.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

New Jersey Healthcare Blog

JANUARY 12, 2022

10:191, Children’s Partial Care Programs, by the Department in 2007; and N.J.A.C. Additionally, an outdated reference to N.J.A.C. 10:37-12, Children’s Partial Care Programs, is being removed because that subchapter was recodified within N.J.A.C. 10:191 was subsequently recodified to N.J.A.C. On November 1, 2021, at 53 N.J.R.

Licensing 40

Licensing Medicaid Medicaid Nurses 40

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. Launched in 2007, star ratings enable the CMS as well as consumers to compare health plans on metrics other than cost. Read More – Medicare Star Ratings Changes 2021 .

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Verisys

FEBRUARY 1, 2022

Providers also need an NPI prior to enrolling in Medicare. In July 1993, the Centers for Medicare and Medicaid Services ( CMS ) undertook a project to develop a healthcare provider identification system to meet the needs of the Medicare and Medicaid programs and the needs of a national identification system for all providers.

Fraud 52

Fraud Medicare Medicare HIPAA 52

Health Populi

FEBRUARY 21, 2019

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs. recorded in 1990-2007. is expected to grow by 5.7%

Medicare 91

Medicare Medicare Medicaid Medicaid 91

Healthcare Law Blog

MAY 25, 2022

First, the decision resolved a previous split between the Fifth Circuit and the Eleventh Circuit; the latter of which ruled, in 2007, that emotional distress damages are available under the Rehab Act. [1] The Supreme Court communicated its intent to limit enforcement in several ways. But what constitutes “traditional” contract damages?

ACA 52

ACA Governance Medicaid Medicaid 52

Kaiser Health News

APRIL 22, 2022

A 2020 study found that the list price of insulin products increased by 262% from 2007 to 2018, while a 2021 study found that from 2014 to 2018 the list price of insulin products increased by 40%. The House bill would cap the cost of insulin at $35 per month for individuals who have private insurance or for those on Medicare.

Pharmaceutical Industry 118

Pharmaceutical Industry ACA Health Care Reform Medicare 118

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. Medicare Advantage plans accept a set fee from the government for covering a person’s health care.

Medicare 105

Medicare Medicare Governance Overpayments 105

Jane Sarashon

DECEMBER 20, 2023

Dr. Robert Pearl has recently written about this, and the phenomenon has been a major recurring theme in this Health Populi blog since its inception in 2007 – when I launched this site in the midst of The Great Recession. There’s a sort of health care “shrinkflation” that has been shaping patients-as-payors of medical bills.

Prescription Drug Pricing 67

Prescription Drug Pricing Medical Billing Health Insurance Public Health 67

Health Populi

MARCH 2, 2020

[As an important sidebar for context, Fidelity Investments estimates that a couple retiring in 2019 would need $285,000 for health care costs in retirement, not including long-term care expenses, to cover expenses that Medicare would not reimburse].

Health Insurance 110

Health Insurance Medical Billing Medicare Medicare 110

Drug & Device Law

JANUARY 25, 2024

142 (2007), mere regulation of the product or conduct at issue—the medical walker is a non-prescription, Class I medical device with general controls only—is not a basis for removal under this statute. The UHC entities offered a number of arguments that involve details of Medicare Part C that we will leave to others.

Medicare 52

Medicare Medicare FDA Regulatory Compliance 52