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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Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

JUNE 8, 2012

The Centers for Medicare & Medicaid Services (CMS) is planning to move forward with the Recovery Audit Prepayment Review (RAPR) Demonstration Project on [stat.] June 1, 2012. It was originally scheduled to begin January 1, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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HIT Consultant

SEPTEMBER 8, 2022

From 2010-2012, he led the execution of natural language processing supplier CodeRyte’s rapid growth plan, culminating in its strategic acquisition by 3M in 2012. Outside of Cerner, Trigg has extensive experience scaling early-stage growth businesses.

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Electronic Medical Records Medicare Medicare Governance 98

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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Medicare Medicare COVID-19 Public Health 52

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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The Health Law Firm

FEBRUARY 4, 2016

Board Certified by The Florida Bar in Health Law The Department of Health and Human Services Office of Inspector General (OIG) flagged various Medicare providers as having questionable billing practices for ophthalmology services rendered in 2012. Indest III, J.D.,

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HIT Consultant

OCTOBER 20, 2023

Curana has achieved this through a provider-led medical group, Medicare Advantage health plans, a Medicare Shared Savings Program (MSSP), and a newly formed ACO REACH organization. This expansion has provided over 750 healthcare providers with the opportunity to excel in value-based care delivery.

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Nurses Medicare Medicare Health Outcomes 59

HIT Consultant

MARCH 16, 2023

Jim Collins, President of Medicare MSO Physicians need to keep their billing and coding right to ensure seamless reimbursements from payers. Other than this, some changes in the AI-based solutions used in the healthcare industry and some updates in Medicare payments with respect to chronic care and telehealth services.

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Medical Billing Medicare Medicare Nurses 98

The Health Law Firm

OCTOBER 27, 2015

Board Certified by The Florida Bar in Health Law According to the Department of Health and Human Services Office of Inspector General (OIG), Medicare paid a total of $171 million for ophthalmology services that now warrant further scrutiny. Indest III, J.D.,

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Medicare Medicare 40

The Health Law Firm

MARCH 4, 2013

A report released by the Government Accountability Office (GAO) on February 27, 2013, announced that Medicare will remain a "high-risk" program with respect to its fraud and waste vulnerability. In 2012, according to the report, CMS let more than $44 billion in improper payments go out. Leider, J.D., The Health Law Firm.

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Medicare Medicare Fraud Medicaid 40

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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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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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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Medicare Medicare Hospitals Medicaid 40

The Health Law Firm

JULY 26, 2012

On July 2, 2012 the Officer of Inspector General (OIG) released its Medicare compliance review of West Florida Hospital in Pensacola. According to the audit, the hospital complied with Medicare billing requirements for the documentation majority of inpatient and outpatient claims. Indest III, J.D.,

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Medicare Medicare Compliance Overpayments 40

The Health Law Firm

OCTOBER 23, 2012

On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. These arrests are part of a nationwide initiative to crack down on theft committed by individuals against Medicare. By Dr. Thu Pham, O.D.,

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Fraud Medicare Medicare 40

The Health Law Firm

OCTOBER 18, 2012

Law Clerk, The Health Law Firm On August 9, 2012, the United States Court of Appeals for the Fifth Circuit, located in New Orleans, Louisianna, affirmed the conviction of a patient recruiter in Texas for Medicare Fraud committed after Hurricane Katrina. The patient recruiter was charged with conspiracy to defraud Medicare.

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Fraud Medicare Medicare 40

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.

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Medicare Medicare COVID-19 Medicaid 62

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. The charges were announced by the Department of Justice (DOJ) on June 29, 2012. By Miles Indest. Straw" Owner Allegedly Used to Start Ambulance Company.

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Medicare Medicare Fraud 40

The Health Law Firm

DECEMBER 10, 2012

A Detroit-area registered nurse was sentenced on November 19, 2012, to 30 months in federal prison for his alleged part in a nearly $13.8 million Medicare fraud scheme. Nurse Caught Reportedly Signing False Medicare Claims. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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Nurses Medicare Medicare Fraud 40

The Health Law Firm

NOVEMBER 2, 2012

A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The man was sentenced on October 5, 2012. Man Used Kickbacks and Illegally Solicited Medicare Beneficiaries in Scheme. The claims were almost all for expensive, high-end power wheelchairs.

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Medicare Medicare Fraud 40

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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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. Indest III, J.D., Board Certified by The Florida Bar in Health Law. The arrests were made in seven cities nationwide, but more than half took place in South Florida.

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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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Medicare Medicare Fraud Medicaid 40

The Health Law Firm

AUGUST 8, 2012

The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice (DOJ), the FBI and the Department of Health and Human Services (DHHS). To see the entire press release from the Department of Justice (DOJ), click here.

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US Department of Health and Human Services Fraud Medicare Medicare 40

The Health Law Firm

NOVEMBER 9, 2012

On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the US Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources.

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US Department of Health and Human Services Medicare Medicare Hospitals 40

The Health Law Firm

SEPTEMBER 12, 2012

On August 16, 2012, the Office of Inspector General (OIG) released a report on questionable billing by mental health centers. The report focuses on the nation’s mental health clinics that overbilled Medicare in 2010, some by tens of millions of dollars. Big Busts in Two South Florida Mental Health Clinics for Medicare Fraud.

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Fraud Medicare Medicare 40

The Health Law Firm

JUNE 8, 2012

A federal jury convicted two South Florida doctors, one Miami-area therapist, and two other individuals for their participation in a Medicare fraud scheme. The jury reached a decision on June 1, 2012. To see the Department of Justice press release, click here.

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Fraud Doctors Medicare Medicare 40

The Health Law Firm

OCTOBER 25, 2012

Two South Florida doctors, both former medical directors at the mental health care company American Therapeutic Corporation (ATC), will spend 10 years in prison for their part in a $205 million Medicare fraud scheme. A US district judge handed down the sentence on October 1, 2012.

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Fraud Doctors Medicare Medicare 40

HIT Consultant

MAY 9, 2023

BST was founded in 2012 by a group of MIT-trained experts in data science, including Dimitris Bertsimas, Ph.D., What You Should Know: MultiPlan , a provider of data-enabled cost management, payment, and revenue integrity solutions for 700+ healthcare payors announced the acquisition of Benefits Science LLC (BST) for $160M in cash and stock.

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Governance Medicare Medicare 52

CMS.gov

APRIL 30, 2018

CMS Encourages Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention Program Model. For the first time, both traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. keya.joy-bush@…. Mon, 04/30/2018 - 10:58. Seema Verma. Initiatives.

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Medicare Medicare US Department of Health and Human Services Medicaid 22

Healthcare IT Today

MAY 18, 2023

Furthermore, the acquisition of BST strengthens MultiPlan’s foothold in large and fast-growing adjacent markets by unlocking the value of its significant and expanding claims flows for in-network commercial, Medicare Advantage and other government programs, property and casualty, and supplemental insurance markets.

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Governance Health Outcomes Medicare Medicare 74

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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HIPAA Compliance Medicare Medicare 96

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). 3729(b)(1)(A). The public has until 5 p.m.

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Overpayments Overpayment ACA Medicare 52

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. Medicare Advantage and Part D) for a comprehensive assessment of a health plan’s performance. Read More – Medicare Star Ratings Changes 2021 . Industry trends.

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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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Healthcare IT Today

DECEMBER 17, 2023

Though this is a significant increase from 2012, numbers haven’t budged much since 2015. Pennsylvania-based WellSpan Health selected Arcadia data analytics to supports its Medicare Shared Savings Program. News In a blog post, ONC highlighted trends in patient access to electronic health information.

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Hospitals Nurses Compliance Regulatory Compliance 92

HIPAA Journal

MAY 18, 2023

The review of the affected files confirmed they contained information such as names, date of birth, addresses, phone numbers, email addresses, driver’s license numbers, Social Security numbers, diagnoses, disability codes, Medicare ID numbers, and health plan carrier information.

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Ransomware HIPAA Licensing Medicare 92