American Medical Compliance

JANUARY 9, 2024

The term refers to the act of taking use of a patient’s or provider’s personal medical data in order to deceive payers, either public or private, or to charge them for false medical products or services. This type of theft is just one example of healthcare fraud.

Fraud 52

Fraud Medicare Medicare Compliance 52

HIT Consultant

AUGUST 17, 2023

have been putting band-aids on the problem of maternity care deserts , propping up existing services for pregnant women and new mothers with temporary fixes. They also serve a majority of Medicaid and non-insured patients, which makes it harder to keep the doors open on maternity wards, whose cost of upkeep can be substantial.

Medicaid 98

Medicaid Medicaid Doctors Telemedicine 98

MedTrainer

NOVEMBER 27, 2023

The Department of Community Health (DCH) serves as the lead agency for Medicaid and PeachCare for Kids® , and also oversees the State Health Benefit Plan , Healthcare Facility Regulation Division and State Office of Rural Health. The Medical Assistance Plans Division oversees Georgia’s Medicaid and PeachCare for Kids® programs.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

The Health Law Firm

FEBRUARY 21, 2014

Board Certified by The Florida Bar in Health Law A licensed speech therapist faces up to five years in prison for allegedly defrauding Medicaid during the summer of 2013. Indest III, J.D., Click here to read the press release from the AG.

Medicaid 40

Medicaid Medicaid Fraud Licensing 40

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Health Law Attorney

APRIL 22, 2021

President Obama issued a Sequestration Order in March 2013. In response, the Centers for Medicare & Medicaid Services (“ CMS ”) issued guidance that Medicare fee-for-service (“ FFS ”) claims with dates of service after April 1, 2013 would incur a 2% reduction in Medicare payment.

Medicare 40

Medicare Medicare COVID-19 Medicaid 40

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. A West Virginia ophthalmologist and his practice have paid $907,074.64

Medicare 59

Medicare Medicare Medicaid Medicaid 59

The Health Law Firm

SEPTEMBER 20, 2013

Board Certified by The Florida Bar in Health Law A Broward County, Florida, home health care company is accused of overbilling the Medicaid program for patient services by almost $500,000, according to the Sun Sentinel. Click here to read the Sun Sentinel article from September 18, 2013. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Fraud 40

Healthcare IT Today

FEBRUARY 27, 2024

HealthBeacon develops connected devices that enable patients with chronic conditions to manage their injectable medication regimens at home and provides other health services. HealthBeacon was founded in 2013 in Dublin, Ireland. Postal Service’s approved mail-back program.

FDA 81

FDA Licensing Medicaid Medicaid 81

The Health Law Firm

JULY 8, 2013

Board Certified by The Florida Bar in Health Law The owner of a Lake County, Florida, medical center was arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) on June 27, 2013, for allegedly committing $300,000 in Medicaid fraud. Indest III, J.D., To read the press release from the AG, click here.

Fraud 40

Fraud Medicaid Medicaid 40

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

Med-Net Compliance

OCTOBER 19, 2022

The settlement resolves allegations that between 2013 and 2020, the company paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients. The skilled services must be based upon a patient’s ability, need, and what is reasonable for the patient.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Medicaid 59

The Health Law Firm

SEPTEMBER 3, 2013

million to settle claims it overbilled Medicare and Medicaid for cancer clinical trial services that were not permitted by the Medicare and Medicaid rules. This announcement from the Department of Justice (DOJ) was released on August 28, 2013. Emory University Allegedly Received Payment Twice for Same Services.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

HIT Consultant

NOVEMBER 8, 2021

States can also decide how they want to determine Medicaid eligibility. While popular back in 2013, custom solutions have proven in most cases to be too costly and time-consuming to be sustainable. Consider how you want the SBM to work with Medicaid. These are just a few of the many decisions a state will need to make.

Health Insurance 98

Health Insurance Medicaid Medicaid Governance 98

Healthcare Compliance Blog

JANUARY 14, 2022

Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. The United States alleges that between 2013 and 2018 the shoe company sold diabetic shoe inserts that were represented to be custom made for an individual’s foot but were actually made using generic foot models.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare IT News - Telehealth

OCTOBER 19, 2020

In the suit, the EHR giant argues that it has used the CarePort trademark since 2013 and that in 2018 the telemedicine company changed its name from ER at Home to CarePortMD. Earlier this summer, CarePort launched a tool to help hospitals comply with the Centers for Medicare and Medicaid Services' interoperability final rules.

Telemedicine 118

Telemedicine Medicaid Medicaid Hospitals 118

The Health Law Firm

AUGUST 19, 2013

million to settle civil allegations under the False Claims Act, according to the Department of Justice (DOJ) on August 16, 2013. The nonprofit organization is accused of fraudulently billing Medicaid and other government programs for health services provided by some of its Texas clinics between 2003 and 2009, according to the DOJ.

Medicaid 40

Medicaid Medicaid Fraud Governance 40

Healthcare IT News - Telehealth

JULY 18, 2022

The telemedicine program of the Charlottesville-based University of Virginia Health System was established in 1995 to enhance timely patient access to healthcare services, particularly for patients in rural regions of the Commonwealth of Virginia. There are many vendors of telemedicine technology and services on the health IT market today.

COVID-19 154

COVID-19 Telemedicine Electronic Medical Records Hospitals 154

MedTrainer

SEPTEMBER 8, 2023

The breach occurred in 2013 when four unencrypted laptops containing the electronic protected health information (ePHI) of over 4 million patients were stolen from an Advocate Health administrative building. Details of the settlement indicate the submission of false claims to Medicare, Medicaid, TRICARE, and FECA programs.

Compliance 52

Compliance HIPAA Medicaid Medicaid 52

Healthcare Compliance Blog

MAY 9, 2022

A home health services company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida. Issue: All submitted claims must be accurate and truthful.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Compliance 59

McGuire Wood

OCTOBER 2, 2023

According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. The disclosure noted that claims for certain referred services were submitted for payment to Medicare, thus invoking the reach of the implicated federal laws. These are key reasons to self-disclose. CMS Voluntary Self-Disclosure.

Fraud 52

Fraud Governance Compliance Medicare 52

HIPAA Journal

FEBRUARY 23, 2022

The responsibility for accomplishing this purpose is delegated to the Secretary for Health & Human Services (HHS). In addition, consumers of federal programs such as Medicare and Medicaid also have privacy rights under the Privacy Act 1974 – but only for records maintained by the Centers for Medicare & Medicaid Services (CMS).

HIPAA 88

HIPAA Fraud Health Insurance Medicaid 88

Healthcare IT News - Telehealth

APRIL 22, 2021

They call the new model a "radical departure from the transactional, fee-for-service model that underpins much of American health care. Those organizations began working together 2019, focused on a value-based payment agreement to improve care and wellness for Medicaid patients in the state.

Medicaid 167

Medicaid Medicaid Public Health 167

Healthcare IT Today

AUGUST 7, 2022

residents would use digital services to access healthcare. However, only 46% consider the information they send to the National Health Service to be secure, and only 40% would be willing to share information digitally with providers who aren’t part of the NHS system. News and Studies .

Governance 82

Governance Telemedicine Medicaid Medicaid 82

Verisys

NOVEMBER 14, 2023

Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic, 20 years ago. Choosing an Experienced Partner Although credentialing software or engaging a CVO may be new to your organization, it’s not a new field.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Provider Trust

MAY 18, 2022

All companies rely on third parties, independent contractors, suppliers and other key partners in order to effectively perform their services. at a provider that furnishes items or services payable by Federal health care programs. Moon , for submitting claims while excluded from March 2006 through July 2013.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Provider Trust

MAY 17, 2022

The answer is simple – a healthcare vendor is defined as any entity or individual that is paid by a healthcare organization for goods or services. Vendor Z provides contract janitorial services. As such, its staff visits on site to perform services and have access to patient rooms, equipment, medications and/or personal items.

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. The Final Rule went into effect on June 5, 2023, and can be found here.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

HIT Consultant

APRIL 20, 2022

healthcare system has been moving towards value-based care (VBC) which encourages health providers to improve care quality by reimbursing them based on successful outcomes rather than individual medical services. This can lead to an increased use of health services, many of which may be preventable.

Medicare 98

Medicare Medicare Telemedicine Medicaid 98

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). Since 2013, CMS has required drug plan sponsors to report the PRC on PDE.

Medicare 52

Medicare Medicare Nurses Medicaid 52

Healthcare Law Blog

MAY 31, 2022

Developers and other players in the metaverse offering health-related products and services will face an ever-growing patchwork of state and federal privacy and data security laws. Many types of healthcare services, ranging from mental health therapy to a dermatology appointment, have the potential to be offered through the metaverse.

FDA 90

FDA HIPAA Medicare Medicare 90

Innovaare Compliance

FEBRUARY 7, 2022

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to whom the company delegates those obligations.

Compliance 52

Compliance Medicare Medicare Medicaid 52

Medval Compliance Blog

MARCH 10, 2022

by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047). 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

The Health Law Firm

MARCH 6, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) continues to stop fraudulent repayment claims before they happen. The agency performed a similar enrollment moratorium in July 2013. Indest III, J.D., Click here to read the press release from CMS.

Medicaid 40

Medicaid Medicaid Fraud Medicare 40

The Health Law Firm

AUGUST 30, 2013

Board Certified by The Florida Bar in Health Law On August 2, 2013, the Centers for Medicare and Medicaid Services (CMS) released the 2014 Inpatient Prospective Payment System (IPPS) Final Rule (the 2014 IPPS Final Rule). By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D.,

Hospitals 40

Hospitals Payment Systems Medicaid Medicaid 40

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 million, according to the Department of Justice (DOJ) on September 13, 2013. Indest III, J.D.,

Fraud 40

Fraud Medicaid Medicaid Medicare 40

The Health Law Firm

AUGUST 21, 2013

Board Certified by The Florida Bar in Health Law On August 19, 2013, Shands Healthcare agreed to pay $26 million to settle a lawsuit that stemmed from a whistleblower/qui tam claim. Indest III, J.D., Click here to read the entire settlement agreement.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40