Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. MAOs will be required to remit improper payments identified during RADV audits in a manner specified by CMS.

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Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Refining Definitions for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

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C&M Health Law

JANUARY 25, 2023

Telehealth Section 4113 of the Act extends certain Medicare telehealth flexibilities that were allowed during the COVID-19 PHE for two years, through 2024. The section ensures that telehealth flexibilities under Medicare are extended for two years, regardless of the status of the PHE.

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Health Law Attorney

APRIL 22, 2021

The Act extends the temporary suspension of certain mandatory Medicare FFS claim payment reductions until December 31, 2021. By way of background, the Budget Control Act of 2011 required mandatory across-the-board reductions to be made in federal spending, otherwise referred to as “sequestration.” Continue Reading ?.

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Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

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HealthIT Answers

JULY 27, 2023

The post Federal Trade Commission Withdraws Health Care Enforcement Policy Statements appeared first on Health IT Answers.

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HIT Consultant

JUNE 21, 2023

Additionally, Aledade is continuing its momentum by welcoming two new members of its Board of Directors and a senior executive to lead its Medicare Advantage business. He also served as the United States National Coordinator for Health Information Technology from 2009 to 2011. Dr. David Blumenthal , M.D.,

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Health Law RX

FEBRUARY 9, 2023

Published in 1993, 1996, and 2011, these statements have been relied upon heavily by the healthcare industry and their counsel, even though these guidance documents are non-binding and do not create legal rights or obligations.

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Healthcare IT Today

JULY 10, 2023

Company Adds Two Board Members and a Senior Executive to Lead its Medicare Advantage Business Aledade , the largest network of independent primary care practices in the country, today announced the closing of a $260 million Series F funding round to enhance and acquire services and technology to support its practices.

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Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. two whistleblowers were the doctor’s former?medical

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Healthcare IT News - Telehealth

OCTOBER 26, 2020

The research team studied nearly 250,000 hospital discharges in patients with diabetes from 2005 to 2011. Although the study tracked patients from 2005 to 2011, before the current telehealth boom , it offers yet another piece of evidence for why virtual care is likely to remain a staple in healthcare even after the pandemic.

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Hall Render

FEBRUARY 15, 2022

In December 2021, the Office of Inspector General (“OIG”) of the Department of Health and Human Services published an Issue Brief titled “Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than Wholly Owned Settings” (“Brief”)(available here ). Issue Brief Findings.

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Healthcare IT News - Telehealth

SEPTEMBER 19, 2022

Reforming Medicare payment. The study, published in Mayo Clinic Proceedings, found that the prevalence of burnout among U.S. physicians was 62.8% in 2021, compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014 and 45.5% The result is that one in five physicians intends to leave their current practice within two years. Stopping scope creep.

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Healthcare IT News - Telehealth

JANUARY 5, 2022

Some changes to the Medicare Benefits Schedule for telehealth items in Australia – including the termination of 128 items, amendment of 17 items, and the addition of two more items – have taken effect this week. WHAT IT'S ABOUT. The changes come following the recommendations by the MBS Review Taskforce.

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Healthcare Law Blog

NOVEMBER 1, 2022

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). See 42 U.S.C.

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Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. On January 31, 2023, CMS will begin releasing the results of RADV audits and overpayment demands for payment years 2011 through 2017.

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Healthcare Compliance Blog

MARCH 16, 2022

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

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The Health Law Firm

JANUARY 2, 2013

The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal. Click here to read the entire article from the Wall Street Journal.

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The Health Law Firm

JULY 9, 2012

A Pennsylvania man has been charged in a 23-count indictment in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. Between 2006 and 2011, the man allegedly billed Medicare for transporting kidney dialysis patients who did not medically need ambulance service. By Miles Indest.

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The Health Law Firm

JUNE 11, 2012

Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.

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American Medical Compliance

NOVEMBER 3, 2022

” Starting in 2011, a study led by Dr. Tait Shanafelt, professor of medicine and chief wellness officer at Stanford Medicine in California, has tracked the wellbeing of doctors and professionals across all other industries in the US. Jack Resneck Jr. doctors was 62.8%. These numbers have increased from 38.2% in 2020, 43.9%

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The Health Law Firm

AUGUST 20, 2012

Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida. 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). Indest III, J.D.,

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Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. These provisions are effective for services furnished on or after January 1, 2011. For dates of service calendar years 2027-2029, the reduced coinsurance is 10%. Background for Reduced Co-Insurance.

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Health Care Law Brief

AUGUST 26, 2022

The Centers for Medicare & Medicaid Services (“ CMS ”) recently published the proposed 2023 Physician Fee Schedule (“ PFS ”), which contains several important changes affecting Accountable Care Organizations (“ ACOs ”) that participate in the Medicare Shared Savings Program (“ MSSP ”), including a new Advanced Incentive Program.

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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.

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Health Law Advisor

FEBRUARY 8, 2023

Similarly, the withdrawal seems contrary to the Center for Medicare & Medicaid’s (“CMS’s”) push for ACOs, including the most recent ACO initiative, the ACO Realizing Equity, Access, and Community Health (“ACO REACH”).

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HIPAA Journal

OCTOBER 21, 2022

However, in 2015, Congress partially relented its stance by passing the Medicare Access and CHIP Reauthorization Act which requires the Centers for Medicare and Medicaid to remove Social Security Numbers from Medicare cards and replace them with Medicare Beneficiary Numbers.

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CMS.gov

SEPTEMBER 22, 2020

We know you love to hear about enhancements to the Plan Finder, and we’ll also talk about the dos and don’ts of 1-800-MEDICARE. We also know you’re always interested in what’s happening at the National Medicare Training Program.

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CMS.gov

SEPTEMBER 22, 2020

On December 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule implementing the Physician Payments Sunshine Act, which was included as section 6002 of the Affordable Care Act of 2010.

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Health Populi

JUNE 23, 2022

By April, one-half of people living in America said their financial situation was getting worse, a reversal of fortune from several steady years of personal financial improvement which kicked off in 2011 as the U.S. emerged from the Great Recession of 2008. Yes, that Mark Cuban).

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Health Care Law Brief

JANUARY 18, 2023

The United States Department of Justice (“DOJ”) resolved allegations that, from January 1, 2011 to December 31, 2016, Dr. Pandya violated the FCA when they submitted false claims to Federal health care programs for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies (“Civil Settlement Agreement”). IA with HHS-OIG.

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The Health Law Firm

JULY 16, 2015

The regulatory guidance was proposed by the Centers for Medicare and Medicaid Services (CMS). 26,342 (May 6, 2011). Indest III, J.D., The document is entitled Medicaid Program: Methods for Assuring Access to Covered Medicaid Services , 76 Fed.

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Healthcare Law Blog

FEBRUARY 6, 2023

1, 1996); and (3) The Department of Justice and Federal Trade Commission Statement of Antirust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (Oct. 20, 2011) (together, the “Healthcare Statements”).

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HIT Consultant

OCTOBER 20, 2023

can be attributed to falls, including approximately six percent of Medicare and eight percent of Medicaid expenditures. Fornari co-founded and was the CEO and medical director of Dominion Diagnostics, one of the country’s leading pharmaceutical monitoring laboratories and served there from 1997 to 2011.

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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

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Healthcare IT Today

OCTOBER 18, 2023

Data can be spotty, according to Eye, who says for instance that data from Centers for Medicare & Medicaid Services (CMS) often lacks racial identifications. Jeff Dorkin, vice president of new product development, said that they base analytics on data drawn from Medicare claims, which cover the whole senior population of the U.S.

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Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). 1] Kaiser Family Foundation, Medicaid Postpartum Coverage Extension Tracker (Mar. 31, 2022). [2]

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