Healthcare IT Today

FEBRUARY 26, 2023

million at-risk patients access preventative services – and stronger standards for Medicaid network adequacy – which could give nearly 300,000 additional Black children access to specialty hospitals and drive $912 million annual Medicaid savings due to reduced avoidable admissions. billion total transactions since 2014.

Medicaid 95

Medicaid Medicaid FDA Health Insurance 95

Bill of Health

MAY 22, 2023

Trends in Medicare Spending on Oral Drugs for Chronic Lymphocytic Leukemia From 2014 to 2020. Trends in Spending and Claims for P2Y12 Inhibitors by Medicare and Medicaid From 2015 to 2020. JAMA Netw Open. 2023 Apr 3;6(4):e238835. PMID: 37115553). Cliff ERS, Kesselheim AS, Rome BN, Feldman WB. JAMA Netw Open. 2023 Apr 3;6(4):e237467.

Pharmaceutical Industry 157

Pharmaceutical Industry Medicare Medicare Medicaid 157

Compliancy Group

FEBRUARY 16, 2024

We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. for Medicaid Fraud In March 2014, the Maryland Board of Dental Examiners received complaints against Seyed Hamid Tofigh, DDS, claiming the dentist posed a risk of harm, and suspended his license.

Fraud 52

Fraud Licensing Medicaid Medicaid 52

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). Indest III, J.D.,

Hospitals 40

Hospitals Payment Systems Medicaid Medicaid 40

Healthcare It News

SEPTEMBER 24, 2021

The four in 10 individuals who accessed a patient portal in 2020 represents a 13 percentage point increase from 2014. Some research shows that patients with lower incomes, Black patients, older patients and patients whose primary insurance is Medicaid are less likely to use portals. At the same time, however, hurdles to access exist.

COVID-19 355

COVID-19 Medicaid Medicaid 355

Bill of Health

FEBRUARY 23, 2022

Medicaid Spending on Drugs Marketed Without US Food and Drug Administration Approval in 2020. Differences in Diabetic Prescription Drug Utilization and Costs Among Patients With Diabetes Enrolled in Colorado Marketplace and Medicaid Plans, 2014-2015. Epub ahead of print. Frank RG, Shahzad M, Kesselheim AS, Feldman W.

Medicaid 144

Medicaid Medicaid Medicare Medicare 144

HIT Consultant

MARCH 2, 2023

Centers for Medicare and Medicaid Services (CMS) to continue its work supporting Healthcare.gov. – In 2014, Accenture Federal Services was awarded a prime contract to take over management of the Federally-Facilitated Exchange (FFE).

Health Insurance 52

Health Insurance Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

HIT Consultant

JULY 14, 2023

FCA Allegations The allegations contends that NextGen falsely obtained certification for its software in connection with the 2014 Edition certification criteria published by HHS’s Office of the National Coordinator. The whistleblowers in this case will receive $5.58M.

Governance 89

Governance Medicaid Medicaid Medicare 89

McGuire Wood

AUGUST 2, 2022

Founded in 2006, the company specializes in motor vehicle accident, third-party liability, workers’ compensation, Veterans Administration, out-of-state Medicaid, and Medicaid eligibility and enrollment claims. Founded in 2014, VHP aims to commit equity investments ranging from $20 million to $60 million.

Medicaid 52

Medicaid Medicaid 52

Kaiser Health News

MARCH 15, 2022

But the new benefit for people enrolled in Medi-Cal, the state’s Medicaid health insurance program, has been delayed twice as the state and doulas — nonmedical workers who help parents before, during, and after birth — haggle over how much they should get paid.

Medicaid 80

Medicaid Medicaid Health Insurance Public Health 80

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

The Health Law Firm

JANUARY 29, 2015

This hypothetical situation begs the question: Why would physicians agree to treat Medicaid patients? Treating Medicaid patients has never been a money maker for physicians. However, for the past two years, Medicaid programs have been required to reimburse primary care providers at Medicare levels, which is typically higher.

Medicaid 40

Medicaid Medicaid ACA Medicare 40

Kaiser Health News

JANUARY 12, 2024

Under the law, which has offered coverage through state and federal marketplaces since 2014, insurers are barred from rejecting people with preexisting conditions and cannot charge higher premiums for them, either. For those with very low incomes, the law expanded eligibility for Medicaid, which is a state-federal program.

Health Insurance 133

Health Insurance ACA Medicaid Medicaid 133

The Health Law Firm

AUGUST 22, 2016

Board Certified by The Florida Bar in Health Law On July 11, 2016, a federal appeals court stated that a bankruptcy judge did not have the authority to block government health officials from cutting off Medicare and Medicaid payments to a Florida nursing home that was alleged to have violated patient-care regulations. Indest III, J.D.,

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Medicaid Medicaid 40

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Health Populi

JUNE 18, 2021

workers with private insurance more likely report poor access to health care, greater costs of care, and lower satisfaction with care versus people covered by public health insurance plans — whether Medicaid, Medicare, VHA or military coverage. Health Populi’s Hot Points: U.S. households.

ACA 133

ACA Health Insurance Medicaid Medicaid 133

Healthcare IT Today

APRIL 21, 2023

Funding Will Grow Medication Adherence Services for Medicaid and Other Under-Resourced Populations Scene Health , the leading medication engagement company, has closed an oversubscribed $17.7 This financing brings the total investment in Scene to over $25 million since its founding in 2014.

Medicaid 56

Medicaid Medicaid Medicare Medicare 56

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

HIPAA Journal

SEPTEMBER 11, 2023

In 2016, a media outlet reported that members of the health plan were able to access the protected health information (PHI) of other members via the online member portal over a 2-day period in 2014 due to a manual processing error. OCR informed L.A. Care Health Plan it had initiated a compliance review and in February 2016, L.A. The post L.A.

HIPAA 73

HIPAA Compliance Medicaid Medicaid 73

Kaiser Health News

DECEMBER 10, 2021

Health care experts and recent studies say Medicaid expansion helps keep hospitals afloat because it increases the number of adults with low incomes who have health insurance. The center’s data shows that 86 of the 129 hospitals that closed in that time were in Texas and the Southeast.

Hospitals 136

Hospitals Medicaid Medicaid COVID-19 136

Med-Net Compliance

AUGUST 16, 2022

In addition, from in and around June 2014 to in and around June 2021, the CEO conspired with two regional-level employees and others to commit healthcare fraud. Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment.

Fraud 59

Fraud Nurses Medicaid Medicaid 59

Med-Net Compliance

OCTOBER 19, 2022

They agreed to be excluded from participating in Medicare, Medicaid, and all other federal healthcare programs for a period of five years. The whistleblowers also alleged other claims under the False Claims Act and Oklahoma Medicaid False Claims Act. The corporate officers were previously the CEO and COO of the company.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Medicaid 59

Verisys

MARCH 23, 2023

This is the largest amount recovered under the False Claims Act since 2014. The Most Common False Claims The FCA primarily combats healthcare fraud and abuse associated with Medicare and Medicaid. Violation of this law requires health services to be payable by Medicare or Medicaid. government or a government contractor.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

The Health Law Firm

APRIL 8, 2014

Board Certified by The Florida Bar in Health Law On March 17, 2014, Carousel Pediatrics in Austin, Texas, agreed to pay the state a $3.75 By Lenis L. Archer, J.D., The Health Law Firm and George F. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid 40

VW Health Care Law Blog

NOVEMBER 9, 2016

The Centers for Medicare and Medicaid Services finalized a rule in March 2014 that required healthcare providers prescribing medication, where the prescription is paid for by a Medicare Part D plan, to enroll in Medicare as a prescriber.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Populi

MARCH 22, 2022

Cancer patients living in state that had not yet or only recently expanded Medicaid also were more likely to report medical debt and being less prepared for the costs of cancer care. As with many aspects of U.S. The CFPB report also examined households with all medical debt by race and ethnic origin of the householder.

COVID-19 68

COVID-19 Medicaid Medicaid Medical Billing 68

The Health Law Firm

SEPTEMBER 18, 2017

The charges allege embezzling more than $500,000 of the clinic's money and diverting it to her personal account, from approximately August through September of 2014. Much of the money came from reimbursement the clinic received from the state's Medicaid program. The Investigation.

Fraud 40

Fraud Medicaid Medicaid 40

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”). Additional Opportunities for Integration through State Medicaid Agency Contracts.

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 Sachin Patel, Chief Executive Officer, Apixio The lack of a complete and comprehensive patient record limits the ability of the physician to improve care and puts organizations at financial and regulatory risk.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

MedTrainer

NOVEMBER 20, 2023

Ensuring adherence to licensing requirements, the Florida Agency for Health Care Administration oversees Medicaid, coordinating essential healthcare access to vulnerable populations. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

Compliance 52

Compliance Licensing Regulatory Compliance Medicaid 52

HIT Consultant

FEBRUARY 20, 2024

They alleged that these procedures were performed unnecessarily, driven by a corporate strategy to maximize profits by overtreating children from lower-income families enrolled in Medicaid. Zion’s demise was attributed to “brain damage caused by a lack of oxygen,” as per the lawsuit.

Health Insurance 52

Health Insurance Medicaid Medicaid Governance 52

The Health Law Firm

JANUARY 13, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) is proposing to exclude providers from Medicare if the government determines a pattern of abusive prescribing practices of Medicare Part D drugs. CMS described these efforts on January 6, 2014, in a proposed rule. Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Hall Render

FEBRUARY 27, 2023

Health Care Fraud Actions Medicaid. The Medicaid program was a target in 2022. DOJ recovered $260 million from a pharmaceutical company for its underpayment of rebates to the Medicaid program by improperly designating one product as a new drug. It also recovered $70.7 A pharmaceutical company paid $843.8

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

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 six-month moratorium began January 31, 2014. Indest III, J.D., Click here to read the press release from CMS.

Medicaid 40

Medicaid Medicaid Fraud Medicare 40

The Health Law Firm

DECEMBER 11, 2014

Board Certified by The Florida Bar in Health Law Stop me if you've heard this one before: the Centers for Medicare and Medicaid Services (CMS) recently increased Medicare's authority over physicians and other health care providers. On December 3, 2014, CMS released these new anti-fraud measures. Indest III, J.D.,

Medicare 40

Medicare Medicare Fraud Medicaid 40

The Health Law Firm

JUNE 6, 2014

Under a rule finalized by the Centers for Medicare and Medicaid Services (CMS) on May 19, 2014, doctors and other health care professionals will be required to enroll in the Medicare program, or have a valid opt-out affidavit on file, for prescriptions to be covered under Part D. By Lance O. Leider, J.D., The Health Law Firm.

Medicare 40

Medicare Medicare Medicaid Medicaid 40