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”). and 422.107).

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C&M Health Law

JANUARY 25, 2023

Health Care Provisions included in the Consolidated Appropriations Act, 2023 The following sections outline the Act’s health care provisions and accompanying explanatory report and provide funding levels for Department of Health and Human Services (HHS) agencies.

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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. Attorney Kurt R. Update as needed.

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Healthcare Law Blog

JANUARY 26, 2023

Department of Health and Human Services (“HHS”) published a notice of proposed rulemaking entitled “Safeguarding the Rights of Conscience as Protected by Federal Statutes” (the “ Proposed Rule “). Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. On January 5, 2023, the U.S.

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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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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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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 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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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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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 ).

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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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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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Medisys Compliance

JULY 27, 2022

CMS is planning to gradually reduce this coinsurance until it’s completely free for dates of service on or after January 1, 2030. For dates of service calendar years 2027-2029, the reduced coinsurance is 10%. For dates of service on or after calendar year 2030, Medicare waives the coinsurance.

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The Health Law Firm

JANUARY 2, 2013

The Office of Inspector General (OIG) of the US Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer's centers across the country.

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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.

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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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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”). Statement 8 for Physician Network Joint Ventures This Statement created a safety zone for physician networks.

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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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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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HIPAA Journal

OCTOBER 21, 2022

The reduction in insurance fraud meant that plan members did not have to cover the cost of HIPAA´s portability provisions through increased premiums, while patients requiring health services did not have to wait so long for treatment to be provided. Only one penalty was issued in each of 2008 and 2009, 2 in 2010, 3 in 2011, and 6 in 2012.

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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? Or perhaps the top 10 Healthcare Common Procedure Coding System (HCPCS) codes for services provided in 2008?

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Health Care Law Brief

JANUARY 18, 2023

In recent years, there have been only a handful of corporate integrity agreements (“CIAs”) and integrity agreements (“IAs”) that have included a “conditional exclusion release” of the Office of the Inspector General for the United States Department of Health and Human Services’ (“HHS-OIG”) permissive exclusion authority under 42 U.S.C.

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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. Pharmacies can also use the information to choose which services to launch. The percentage is much higher in some areas.

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The Health Law Firm

JULY 16, 2015

Board Certified by The Florida Bar in Health Law The House Committee on Energy and Commerce and the Senate Committee on Finance both recently sent a letter to Secretary Burwell urging the US Department of Health and Human Services (HHS) to actually issue the Medicaid Equal Access regulations. 26,342 (May 6, 2011). Indest III, J.D.,

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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

In that report, Guardian, an insurance and financial services company, asked people to rank the macro factors that shape their wellbeing. billion savings that Medicare Part D could accrue if the program bought generic drugs at the prices offered through the Mark Cuban Cost Plus Drug Company. emerged from the Great Recession of 2008.

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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.

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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. Falls among older adults also accounted for nearly 12 percent ($29 billion) of spending on home health services, long-term care facilities, and durable medical equipment.

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Health Populi

OCTOBER 24, 2022

The second drawing illustrates the fact that health care service patterns have not returned to their pre-pandemic levels. Aside from care for COVID-19, volumes are down except for services related to mental and behavioral health (with rates of mental health prescribing increasing for antidepressant and anti-anxiety drugs). That was 2.7

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Health Law Advisor

AUGUST 10, 2023

According to the preamble to the 2011 Final Rule: A purchaser of an MDDS who has only used, configured, or modified the MDDS in accordance with the original manufacturer’s labeling, instructions for use, intended use, original design, and validation would not be considered a manufacturer for purposes of this regulation. 10] 76 Fed.

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Hall Render

FEBRUARY 14, 2023

1, 1996); and Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (Oct. The three policy statements include, Department of Justice and FTC Antitrust Enforcement Policy Statements in the Health Care Area (Sept.

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The Health Law Firm

SEPTEMBER 23, 2013

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 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.,

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Hall Render

MARCH 16, 2022

It’s also the first bicameral legislation to include community project funding (previously known as “earmarks”) since they were banned in 2011. Health and Human Services Department. billion for the Public Health and Social Services Emergency Fund, a $352.2 billion for the Public Health and Social Services Emergency Fund, a $352.2

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HIT Consultant

FEBRUARY 8, 2023

Kishore Pendyala, CEO of KP-Tech Services The Fast Healthcare Interoperability Resources (FHIR) standard was introduced by HL7 in 2014 as a significant replacement for the HL7 V2 and V3 standards. An open standard called FHIR, which was initially drafted in 2011, makes it easier than ever for legacy systems and new apps to exchange data.

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The Health Law Firm

AUGUST 2, 2012

On July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law. ” To see the official announcement from the CMS, click here.

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New Jersey Healthcare Blog

JANUARY 12, 2022

1783(a), the Department of Human Services, Division of Medical Assistance and Health Services adopted new rules regarding nursing facility patient care ratio requirements. 1788(a), the Department of Human Services, Division of Medical Assistance and Health Services readopted a rule regarding chiropractic services.

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