2010, Fraud and Medicaid - Health Care Compliance Brief

ProviderTrust Achieves 2 Major Milestones – HITRUST Certification and Monitoring of 10 Million Healthcare Individuals and Entities

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse. Healthcare compliance plays an instrumental role in the success of the entire healthcare ecosystem.

Fraud

Fraud Medicaid Medicaid Licensing

ProviderTrust Launches Impact Compliance™ Program to Solve Gaps in Healthcare Compliance Monitoring

Provider Trust

APRIL 18, 2024

ProviderTrust was founded in 2010 with a mission to create a safe healthcare experience for everyone. About ProviderTrust ProviderTrust was founded in 2010 with a mission to create safer healthcare for everyone through OIG and state Medicaid exclusion monitoring. To learn more, visit providertrust.com.

Compliance

Compliance Licensing Fraud Medicaid

Emergency Suspension Orders and Medicaid Fraud

The Health Law Firm

NOVEMBER 7, 2011

Doctor Pleas Nolo Contendre to Fraud Charge. On December 9, 2010, he entered a plea of nolo contendere in federal court to a charge of conspiracy to commit fraud upon the United States in violation of 18 USC. § § 371.

Fraud

Fraud Medicaid Medicaid Licensing

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. This is the second consecutive year the rate has been below the 10 percent threshold for compliance established in the Improper Payments Elimination and Recovery Act of 2010.

Medicare

Medicare Medicare Overpayments Overpayment

The History of Healthcare Compliance

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance in healthcare began to encompass billing, fraud, and abuse prevention. Compliance efforts expanded to encompass EHR security.

Compliance

Compliance HIPAA Telemedicine ACA

2024 Final Rule: CMS Announces More Changes to Medicare Advantage but Declines to Reform the “60 Day Rule”

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. 2010) (quoting S. 3d 173, 191 (D.D.C.

Medicare

Medicare Medicare Overpayments Overpayment

Alachua County Woman Arrested for Exploiting 11 Disabled Adults

The Health Law Firm

SEPTEMBER 19, 2012

The woman was arrested for allegedly stealing money from 11 clients in 2010 and 2011. Investigation by the Medicaid Fraud Control Unit (MFCU) Led to Arrest. To see the press release from the AG, click here.

Fraud

Fraud Medicaid Medicaid

Editorial: 5 Gaps in HIPAA and How They Are Being Filled

HIPAA Journal

OCTOBER 21, 2022

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. 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

HIPAA

HIPAA Compliance Medicare Medicare

A State Roadmap To Successfully Deploy Medicare Modularity (MMIS)

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Prior to SAS, he was the Chief Information Officer of Arkansas Medicaid.

Medicare

Medicare Medicare Medicaid Medicaid

How to Increase Your Health Plan’s CMS Star Ratings to Earn More Revenue In 2021

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. Inovaare’s A&G software optimizes your processes so you can handle large volumes of data, reduce costs and ensure transparency to prevent fraud at every step. References.

Medicare

Medicare Medicare Medicaid Medicaid

Home Health PPS Final Rule for CY 2024: CMS Steps Back from the Brink

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. CMS is finalizing this proposal.

Medicare

Medicare Medicare Payment Systems Medicaid

President Biden Signs End-of-Year Legislation Including Telehealth, Medicare & Medicaid, Mental Health, Pandemic Preparedness, and Other Health Care Provisions

C&M Health Law

JANUARY 25, 2023

hospitalizations and emergency department visits) and to audit Medicare claims to assess potential fraud. In November 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care At Home program to provide hospitals expanded regulatory flexibility and allow them to care for eligible patients in their homes.

Medicaid

Medicaid Medicaid Medicare Medicare

Health Care Compliance Brief

ProviderTrust Achieves 2 Major Milestones – HITRUST Certification and Monitoring of 10 Million Healthcare Individuals and Entities

ProviderTrust Launches Impact Compliance™ Program to Solve Gaps in Healthcare Compliance Monitoring

Trending Sources

Emergency Suspension Orders and Medicaid Fraud

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010

The History of Healthcare Compliance

2024 Final Rule: CMS Announces More Changes to Medicare Advantage but Declines to Reform the “60 Day Rule”

Alachua County Woman Arrested for Exploiting 11 Disabled Adults

Editorial: 5 Gaps in HIPAA and How They Are Being Filled

A State Roadmap To Successfully Deploy Medicare Modularity (MMIS)

How to Increase Your Health Plan’s CMS Star Ratings to Earn More Revenue In 2021

Home Health PPS Final Rule for CY 2024: CMS Steps Back from the Brink

President Biden Signs End-of-Year Legislation Including Telehealth, Medicare & Medicaid, Mental Health, Pandemic Preparedness, and Other Health Care Provisions

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