The Health Law Firm

SEPTEMBER 6, 2012

The director of a center for developmentally challenged adults in Okaloosa County, Florida, was arrested on August 16, 2012, for allegedly fraudulently billing Medicaid for more than $270,000 for services under the Medicaid Developmentally Disabled Waiver Program, according to the Attorney General’s (AG) office.

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Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. See also Ratanasen v.

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The Health Law Firm

JUNE 8, 2012

Connecticut Attorney General George Jepsen alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. Jepsen filed a civil action on May 31, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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The Health Law Firm

SEPTEMBER 21, 2012

A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Indest III, J.D., Board Certified by The Florida Bar in Health Law. Through this scheme, she allegedly obtained at least $6.1

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The Health Law Firm

OCTOBER 26, 2012

According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children.

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The Health Law Firm

AUGUST 2, 2012

The North Carolina Department of Health and Human Services (DHHS) announced on July 25, 2012, in a press release, that it investigated 75 cases for potential Medicaid billing fraud. Investigators Used Data Analytics Software to Detect Questionable Billing Practices.

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Healthcare Law Blog

NOVEMBER 1, 2022

The proposed rule back tracked CMS’s 2012 decision to apply a FFS Adjuster to extrapolated contract-level RADV audits. Under the 2012 announcement, the FFS adjuster was intended to account for any effect of erroneous diagnosis codes in the data from Medicare Parts A and B that are used to calibrate the MA risk adjustment model.

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Healthcare IT Today

JUNE 21, 2023

Inflation will push Payers back into the Public Marketplace whether Statewide and Federal Health Exchanges, Medicaid and Medicare Before the pandemic, many payers left statewide health exchanges as they found more ways to become profitable outside of the public market. In the same time period we have seen a large surge in Medicaid enrollment.

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HIPAA Journal

MARCH 15, 2023

FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida. FHKC is a state-created entity that offers health and dental insurance to children in Florida between the ages of 5 and 18.

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Health Insurance HIPAA Due Diligence Fraud 75

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. CMS previously addressed this problem and provided for a solution in its February 2012 announcement of the FFS Adjuster.

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Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

DECEMBER 17, 2023

Though this is a significant increase from 2012, numbers haven’t budged much since 2015. Pair Team expanded into seven more California counties ; the company provides virtual primary care for Medicaid beneficiaries. News In a blog post, ONC highlighted trends in patient access to electronic health information.

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Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3% in FY 2024 but applies a 0.2%

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The Health Law Firm

OCTOBER 19, 2012

Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. In October of 2012, the Centers for Medicare and Medicaid Services (CMS) announced it has discovered errors in its initial calculations. Indest III, J.D.,

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HIPAA Journal

AUGUST 12, 2022

The affected information included names, pharmacy claim information from certain prescriptions filled in 2012, including drug names, prescription filling dates, and insurance provider names. WNJ said it found no evidence of misuse of plan members’ information, but the possibility of data theft could not be ruled out.

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Licensing Health Insurance HIPAA Medicaid 64

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).

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Healthcare IT News - Telehealth

JULY 18, 2022

"In addition, in 2012, UVA Health launched a remote patient monitoring program to improve patient compliance and clinical outcomes, and to reduce hospital readmissions, hospital length of stay and emergency department visits.

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The Health Law Firm

JUNE 15, 2012

The DOJ announced the settlement on April 20, 2012. Walgreens Allegedly Offered Inducements to Medicare and Medicaid Beneficiaries. The settlement resolves allegations that Walgreens violated the False Claims Act. To view the DOJ's press release concerning the settlement with Walgreens, click here.

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The Health Law Firm

MARCH 4, 2013

The GAO cites the inability of the Center for Medicare and Medicaid Services' (CMS) inability to reduce the rate of improper payments released by the agency as the reason for its ruling. In 2012, according to the report, CMS let more than $44 billion in improper payments go out. Click here to view the full report from the GAO.

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Medicare Medicare Fraud Medicaid 40

The Health Law Firm

OCTOBER 3, 2012

On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration at a Senate Special Committee on Aging. To see the Power Mobility Devices (PMDs) Demonstration operational guide from the Centers for Medicare and Medicaid Services (CMS), click here.

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The Health Law Firm

SEPTEMBER 19, 2012

A former employee of an organization that provides services to developmentally disabled adults in Alachua County, Florida, was arrested on June 15, 2012, according to the Attorney General’s (AG) Office. Investigation by the Medicaid Fraud Control Unit (MFCU) Led to Arrest. To see the press release from the AG, click here.

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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.

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Medicaid Medicaid Doctors Medicare 40

The Health Law Firm

JULY 12, 2012

The nurse was arrested on a felony warrant by the Attorney General’s Medicaid Fraud Control Unit (MFCU). The arrest was announced by the Florida Attorney General on June 29, 2012. A licensed practical nurse (LPN) at Florida State Hospital has been arrested and charged with one count of abuse of a disabled adult at the hospital.

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The Health Law Firm

APRIL 16, 2012

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. BCBS Florida).

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Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

JUNE 11, 2012

The following recent update was released by the Centers for Medicare & Medicaid Services (CMS) on May 30, 2012, updating the original from December 16, 2011: Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from (..)

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Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

MAY 4, 2012

Over 100 doctors, nurses and other health professionals were arrested on charges relating to Medicare fraud by federal agents on May 2, 2012. The arrests were made in seven cities nationwide, but more than half took place in South Florida.

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Fraud Medicare Medicare Medicaid 40

Healthcare IT News - Telehealth

JUNE 3, 2021

Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services. Before joining Geisinger, she served as Pennsylvania’s secretary of health, where she developed an innovative payment and delivery model for rural hospitals. Isaiah Nathaniel. Philadelphia.

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Department of Veterans Affairs COVID-19 COVID-19 Vaccine Nurses 91

Health Populi

AUGUST 5, 2019

” All 50 state Medicaid agencies have adopted some coverage for telehealth, with 10 states not advancing coverage since 2017. There’s a move among state Medicaid programs to migrate from traditional hub-and-spoke models of care, with 29 states not specifying a specific patient setting for payment. health care system.

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Telemedicine Doctors Medicaid Medicaid 81

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The term “knowingly” has the meaning set forth in 31 U.S.C.

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Overpayments Overpayment ACA Medicare 52

HIT Consultant

OCTOBER 6, 2021

It doesn’t even take you to the Centers for Medicare & Medicaid Services (CMS) website. She served as an Executive Vice President of SeniorBridge Family Companies and subsequently Chief of Professional Services at Human At Home after Humana’s acquisition of SeniorBridge in 2012. Try Googling the word “caregiving.”

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COVID-19 Doctors Health Outcomes Licensing 98

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. billion and $11.5

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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.

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Licensing Medicaid Medicaid Nurses 40

CMS.gov

APRIL 30, 2018

The Centers for Medicare & Medicaid Services (CMS) in April expanded the Medicare Diabetes Prevention Program (MDPP) , a national performance-based payment model offering a new approach to type 2 diabetes prevention in eligible Medicare beneficiaries with an indication of pre-diabetes. keya.joy-bush@…. Mon, 04/30/2018 - 10:58. Seema Verma.

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CMS.gov

MARCH 4, 2013

In January, we passed the 210,000 mark for the total number of providers, including nearly 200,000 eligible professionals, who received a Medicaid or Medicare incentive payment for successfully adopting, implementing, or upgrading or meeting meaningful use of EHR technology. Growing EHR Adoption and Meaningful Use. Moving into Stage 2.

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Medicare Medicare Medicaid Medicaid 26

Bill of Health

JULY 8, 2022

Although Professor Levinson wrote this passage in 2012, it is surely just as true — if not more so — today. The outcome of the affirmative action case will have a critical effect on the future composition of the health care workforce.

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Governance Public Health Medicaid Medicaid 144

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. Centers for Medicare & Medicaid. 2012 Quality Bonus Payment Distributions and Administrative Review Process for Quality Bonus Payments and Rebate Retention Allowances.

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Health Populi

OCTOBER 8, 2019

The study reviewed reports and articles published between January 1, 2012 and May 15, 2019, dressing the topic of waste across six domains previously identified by the Institute of Medicine: Failure of care delivery, with waste ranging between $102 bn and $166 bn.

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Prescription Drug Pricing Medicare Medicare ACA 104

Kaiser Health News

APRIL 8, 2022

Prescription drug costs for California’s massive Medicaid program were draining the state budget, so in 2019 Gov. The new Medicaid drug program debuted this January, with a private company in charge. Centene was already a big player in state Medicaid drug programs — but one with a questionable record. SACRAMENTO, Calif.

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Medicaid Medicaid Health Insurance COVID-19 93