Healthcare Compliance Blog

APRIL 29, 2022

Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. in restitution for her role in healthcare fraud, wire fraud, and theft of government funds.

Fraud 59

Fraud Compliance Governance Medicaid 59

The Health Law Firm

APRIL 22, 2013

Edna Lorraine Watkins, the owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has been sentenced to six years in prison for defrauding Medicaid, according to the Florida Office of the Attorney General (AG). She made more than $400,000 in false claims between January 2008 and June 2011. Watkins was sentenced on April 2, 2013.

Medicaid 40

Medicaid Medicaid Fraud 40

Verisys

DECEMBER 1, 2023

It allows organizations to stay compliant with state and federal requirements and maintains their accreditation with Medicare, Medicaid, TRICARE, and other programs. Verisys has been NCQA and URAC accredited since 2008. NCQA certification has become essential to identifying industry standards and quality.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

The Health Law Firm

FEBRUARY 20, 2018

The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said. The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). Indest III, J.D.,

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

Healthcare IT News - Telehealth

MARCH 18, 2022

Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. You are passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. What's happening in this area of digital health?

Medicaid 202

Medicaid Medicaid COVID-19 Telemedicine 202

Hall Render

FEBRUARY 1, 2024

Regulations implementing the Federal Conscience Statutes date back to 2008 and were narrowed substantially by a 2011 revision (the “2011 Conscience Rule”).

Compliance 74

Compliance Medicaid Medicaid 74

MedTrainer

NOVEMBER 28, 2023

Under the state’s Department of Health and Human Resources , Michigan Medicaid works with healthcare providers enrolled with Medicaid programs, provides information about billing, and conducts reporting for Medicaid programs.

Compliance 52

Compliance Licensing Public Health Compliance Officers 52

C&M Health Law

OCTOBER 18, 2023

Section 504 covers all health care and human services programs and activities funded by HHS, from providers, like hospitals and doctors that accept Medicare or Medicare, to state child welfare programs, as well as Medicare Advantage Plans, and Medicaid Managed Care Plans. Comments may be submitted until November 13, 2023.

ADA 98

ADA COVID-19 Medicare Medicare 98

HIPAA Journal

OCTOBER 21, 2022

Despite the benefits, the cost of implementing NPIs was forecast ( in 2008 ) to be between $1.5 Only one penalty was issued in each of 2008 and 2009, 2 in 2010, 3 in 2011, and 6 in 2012. billion and $11.5 While there was a risk of a financial penalty, very few penalties were actually being imposed.

HIPAA 95

HIPAA Compliance Medicare Medicare 95

AIHC

NOVEMBER 29, 2023

The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare Law Blog

DECEMBER 12, 2022

The Centers for Medicare & Medicaid Services (“CMS”) temporarily approved certain telehealth flexibilities during the PHE. The Ryan Haight Act of 2008 generally requires a prescribing practitioner to have conducted at least one in-person medical evaluation of a patient prior to prescribing controlled substances via telehealth.

COVID-19 52

COVID-19 Fraud Telemedicine Public Health 52

AIHC

NOVEMBER 29, 2023

The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Populi

DECEMBER 19, 2018

in 2008, one in three Americans delayed medical treatment due to costs. Underneath this statistic, it’s important to compare the payor mix of patients delaying care: nearly one-third of people with private, commercial insurance delayed care by 2018; 22% of people enrolled in Medicaid or Medicare put off care.

Medicaid 84

Medicaid Medicaid Medicare Medicare 84

Verisys

DECEMBER 22, 2021

Donald Potts has helped healthcare customers define business problems and design innovative solutions since he started at Optum in 2008. As a product manager at the healthcare technology and services company Verisys , he guides many of the solutions that support health plans, health systems, and state Medicare and Medicaid agencies.

Compliance 52

Compliance Regulatory Compliance Healthcare information Technology Health Insurance 52

HIT Consultant

APRIL 20, 2022

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. 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. Tom Zaubler, MD, Chief Medical Officer of NeuroFlow.

Medicare 98

Medicare Medicare Telemedicine Medicaid 98

The Health Law Firm

AUGUST 20, 2012

This is allegedly due to excessive readmission rates in these hospitals between July 2008 and June 2011, according to the Centers for Medicare and Medicaid Services (CMS). Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Health Law Advisor

FEBRUARY 10, 2023

Lowest Total Recoveries Since 2008 Record-Shattering Number of New Cases Filed Health Care and Life Sciences Cases Continue to Dominate On February 7, 2023, the U.S. Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2022, which ended on September 30, 2022. [1]

Fraud 52

Fraud COVID-19 Governance Medicaid 52

Innovaare Compliance

FEBRUARY 14, 2022

This includes CMS regulations for Medicare Plans, regulations for Commercial Plans and Medicaid regulations for state plans. With this in mind, much as possible, find a way to standardize grievance categories so that they can equally apply to CMS reporting, Medicaid reporting and Commercial reporting.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Innovaare Compliance

JANUARY 3, 2022

The Centers for Medicare & Medicaid Services (CMS) began call-center monitoring for timeliness and accessibility in 2015 and has continued since. In 2022, CMS will implement the new audit protocol 10717 for both Part C and D programs, as well as Medicare-Medicaid Plans (MMPs). New CMS Program audit protocol in 2022.

Compliance 40

Compliance Medicare Medicare Medicaid 40

Innovaare Compliance

MARCH 1, 2022

1] The Centers for Medicare & Medicaid Services (CMS) has to establish an annual Part B premium that will adequately fund projected Medicare spending and maintain an adequate reserve in case actual costs are higher than estimated. The monthly premium for Medicare Part B rose 14.5%, from $148.50 in 2021 to $170.00

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Populi

JUNE 13, 2018

Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S. economy by 2026.

Medicaid 63

Medicaid Medicaid Health Insurance Medicare 63

New Jersey Healthcare Blog

JANUARY 12, 2022

1846(a), the Department of Human Services, Division of Medical Assistance and Health Services published a notice of readoption of New Jersey Care … Special Medicaid Programs Manual. The Manual extends Medicaid eligibility to certain persons not eligible under the provisions at N.J.A.C. On November 1, 2021, at 53 N.J.R.

Licensing 40

Licensing Medicaid Medicaid Nurses 40

Health Populi

MARCH 11, 2021

Dr. Fendrick was part of a team that wrote one of the first research articles on the effects of increasing patient cost sharing on health disparities — published in 2008 in the Journal of General Internal Medicine. .” Out of the mouths of Mom’s, right?!

Health Insurance 98

Health Insurance ACA Medicare Medicare 98

Innovaare Compliance

JANUARY 16, 2022

Leaders of healthcare organizations who must adhere to Medicare or Medicaid regulations face an important decision: manage member issues in a single Member Experience Platform or buy several separate case tracking systems and seamlessly integrate them. The choice seems obvious. Internal urgent alerts on aging cases.

Compliance 40

Compliance Medicaid Medicaid Medicare 40

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Bill of Health

SEPTEMBER 9, 2022

Consider that between 2008 and 2020, U.S. If the point of “building back better” — to use the Biden administration’s preferred phrase — is enhancing the public health system’s resilience to future crises, using January 2020 as a benchmark is wholly inappropriate. public health expenditures fell by 30 percent.

Public Health 362

Public Health COVID-19 Public Health Professionals Governance 362

Healthcare IT Today

FEBRUARY 7, 2024

History of EPCS Kyle Zebley, head of public policy American Telemedicine Association (ATA) , says that Congress called on the DEA to implement a policy for a special controlled substance registration process in 2008. This requirement languished for the past 15 years, probably because the DEA had a multitude of competing priorities.

Telemedicine 112

Telemedicine Doctors COVID-19 Medicare 112

Innovaare Compliance

MARCH 30, 2022

On February 2, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Advance Notice). Below are some of the highlights in the Advance Notice and invitation for comments from health plans.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

JANUARY 5, 2022

The Ryan Haight Act of 2008 generally requires prescribers to conduct in-person evaluations before prescribing buprenorphine but adjusting the rule to allow providers to e-prescribe the life-saving medication more broadly would expedite the start of therapy for thousands of patients.

US Department of Health and Human Services 98

US Department of Health and Human Services Telemedicine Governance Medicaid 98

Bill of Health

SEPTEMBER 30, 2022

Most recently, the Fourth Circuit held that gender dysphoria meets the broad definition of disability articulated by Congress in the ADA in 1990 and reiterated in the ADA Amendments Act in 2008. In doing so, the ADA provided a remedy for misgendering, harassment, and violence experienced by a trans woman in prison.

COVID-19 144

COVID-19 ADA Public Health Nursing Homes 144

Jane Sarashon

DECEMBER 22, 2022

The updated ACO Reach payment model from the Centers for Medicare and Medicaid Services (CMS) sets forth a value-based model of capitated payments to physicians who meet quality and spending targets – combined with a plan to deal with health equity. This program will be implemented starting on January 1, 2023.

COVID-19 52

COVID-19 Health Insurance Public Health Hospitals 52

Innovaare Compliance

NOVEMBER 4, 2021

Armed with this regulatory compliance information, you should be in a better position to create accurate universes that comply with the latest Medicare and Medicaid protocols. Inovaare has been providing healthcare organizations with quality services that help them comply to Medicare/Medicaid regulations since 2008.

Regulatory Compliance 52

Regulatory Compliance Medicaid Medicaid Medicare 52

Healthcare IT News - Telehealth

MAY 14, 2020

"Many areas we provide care to did not have much recovery since [the economic crash of] 2008," said Marshfield Clinic Health System CEO Dr. Susan Turney.

Hospitals 192

Hospitals COVID-19 Medicare Medicare 192

Health Populi

JANUARY 24, 2019

Politics underpin what’s happening in health plans in the public sector, and I spoke a bit about Medicare and Medicaid. You can see the latest Medicaid demonstration waiver data from a Kaiser Family Foundation analysis done January 9, 2019 shown in the bar chart.

Medicaid 65

Medicaid Medicaid Doctors Health Insurance 65

Healthcare IT News - Telehealth

OCTOBER 17, 2022

There is also the matter that open enrollment begins on November 1, and without the relaxed enrollment provisions for Medicaid that the PHE provides, the national uninsured rate along with health premium costs would certainly rise. But by definition, an "emergency" can't last forever. What's at stake.

US Department of Health and Human Services 164

US Department of Health and Human Services COVID-19 Telemedicine Public Health 164

HIT Consultant

MARCH 1, 2022

Medicaid systems are struggling as potential expansion looms Clearly, many state unemployment information systems are in dire need of upgrades. For Medicaid, the threat comes as potential expansion looms. Some of today’s Medicaid systems may collapse under the weight of such data and analytics requirements.

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52