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.

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Medicaid Medicaid Health Insurance Public Health 80

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.

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Governance Medicaid Medicaid Medicare 94

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.

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Medicaid Medicaid Governance Fraud 59

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.

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Health Insurance ACA Medicaid Medicaid 133

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.

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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.

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Medicare Medicare Overpayments Overpayment 98

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.

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Medicaid Medicaid Medicare Medicare 57

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.,

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

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. These referrals include any service or item payable by a government healthcare program.

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Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

OCTOBER 19, 2022

The defendants’ alleged conduct resulted in the submission of claims for services provided to these illegally referred patients, in violation of the False Claims Act. They agreed to be excluded from participating in Medicare, Medicaid, and all other federal healthcare programs for a period of five years.

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US Department of Health and Human Services Medicare Medicare Medicaid 59

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.

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Fraud Nurses Medicaid Medicaid 59

Innovaare Compliance

AUGUST 24, 2023

At the heart of the debate is whether Medicare is obtaining good value for the program’s expenditures, i.e., maintaining beneficiaries’ access to high-quality services while encouraging efficient use of resources.

Medicare 52

Medicare Medicare Fraud Medicaid 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 million settlement, after an investigation by the Texas Health and Humans Services Commission Office of Inspector General (OIG) allegedly found a number of billing errors. Archer, J.D.,

Medicaid 40

Medicaid Medicaid 40

Healthcare IT News - Telehealth

AUGUST 21, 2020

MEBS Counseling, a community-based behavioral health provider, offers children and their families evidence-based behavioral health services in the Northern Kentucky area. Most of its patients fall below the poverty line, and most qualify for Medicaid. These patients face difficult socioeconomic barriers that limit their access to care.

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COVID-19 Telemedicine Medicaid Medicaid 205

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

HIT Consultant

FEBRUARY 20, 2024

Over the last decade, private equity firms have invested nearly $1 trillion in approximately 8,000 healthcare deals, encompassing a wide spectrum of medical services, from fertility clinics to neonatal care, primary care to cardiology, hospices, and everything in between. The consequence?

Health Insurance 52

Health Insurance Medicaid Medicaid Governance 52

MedTrainer

NOVEMBER 20, 2023

Healthcare providers, facilities, and organizations in Florida must know how to navigate the regulatory landscape to provide efficient and ethical healthcare services while steering clear of legal and financial pitfalls. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

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Compliance Licensing Regulatory Compliance Medicaid 52

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. Unnecessary Services. It also recovered $70.7 It also recovered $70.7

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Nursing Homes Fraud Medicaid Medicaid 40

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”). CMS will not apply a Fee-For-Service (“FFS”) Adjuster in RADV audits. See also Ratanasen v.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 and 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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

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.

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Medicare Medicare Telemedicine Medicaid 98

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.

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Compliance Medicare Medicare Medicaid 52

Healthcare IT News - Telehealth

JUNE 3, 2021

Al Mahri is also group chief nursing officer at Abu Dhabi Health Services Company, or "SEHA," where she was the first senior nursing leader to identify the importance of the nursing informatics specialty. Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services.

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

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. Smith, R.R.T.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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).

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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 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.

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Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

APRIL 4, 2014

The Health Law Firm On February 28, 2014, the Centers for Medicare and Medicaid Services (CMS) issued its revised emergency preparedness checklist for health care facility planning. By Lenis L. Archer, J.D.,

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule.

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Overpayments Overpayment Medicare Medicare 40

The Health Law Firm

APRIL 21, 2014

Board Certified by The Florida Bar in Health Law For years, the Centers for Medicare and Medicaid Services (CMS) kept private its records on Medicare reimbursement payments made to physicians, however, on April 9, 2014, that all changed. Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

JUNE 4, 2014

A final rule released by the Centers for Medicare and Medicaid Services on May 19, 2014, requires health care providers to enroll in the Medicare program, or have a valid opt-out affidavit on file, for prescriptions to be covered under Part D. Leider, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Care Law Brief

JUNE 26, 2022

Under the traditional, or fee-for-service (FFS), Medicare program, CMS directly pays providers a predetermined rate for the items and services furnished to patients under Medicare Parts A and B. In turn, an MA plan pays providers a negotiated rate for the items and services they render to enrollees. Azar , Civil Case No.

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Overpayments Overpayment Medicare Medicare 52

Health Populi

AUGUST 24, 2018

The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014 , published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. ” Unless this trajectory reverses, multimorbidity trends will continue to drive up healthcare costs in the U.S.

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Public Health Doctors Medicaid Medicaid 72

Healthcare Law Today

JANUARY 2, 2023

If this proposed rule is finalized, the Department of Justice (DOJ) and Health and Human Services (HHS) Office of Inspector General’s (OIG) should be applying the same intent standard to their evaluation of potential reverse false claims and Civil Monetary Penalty liability. 3729(b)(1)(A).

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Healthcare IT Today

JANUARY 4, 2023

A 2021 report by the Department of Health and Human Services estimates that the number of medical visits via telehealth grew from 840,000 in 2019 to 52.7 Healthcare providers maintain different systems than payers, as do government entities like Medicare and Medicaid. billion in 2014. million in 2020.

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US Department of Health and Human Services Doctors Health Outcomes COVID-19 64