Bill of Health

MAY 22, 2023

The selections feature topics ranging from an analysis of government and industry investments for recently approved drugs, to a discussion of court decisions on mifepristone, and an examination of the added therapeutic benefit associated with the top-selling brand-name drugs in Medicare. Galkina Cleary E, Jackson MJ, Zhou EW, Ledley FD.

Pharmaceutical Industry 157

Pharmaceutical Industry Medicare Medicare Medicaid 157

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

Medicare 52

Medicare Medicare Fraud Medicaid 52

HIT Consultant

OCTOBER 27, 2023

has seen a consistent decline in primary care clinicians since 2014 due to fewer clinicians entering the workforce, increased rates of burnout and decreased direct patient care, according to the latest evidence report from the Primary Care Collaborative and Robert Graham Center. In 2022, MSSP saved Medicare $1.8

COVID-19 98

COVID-19 Medicare Medicare Hospitals 98

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 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

Bill of Health

JULY 15, 2022

Potential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. Post-Marketing Requirements for Cancer Drugs Approved by the European Medicines Agency, 2004-2014. JAMA Netw Open. 2022 Jun 1;5(6):e2216183.

Public Health 205

Public Health Medicare Medicare Governance 205

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

HIT Consultant

APRIL 11, 2022

Specializing in Medicare Value-Based Care Programs. Vytalize Health started as a Medicare-focused primary care practice in New York in 2014. The company will use the new capital to continue investing in its care delivery infrastructure, partner with Medicare Advantage and commercial plans, and expand its team. ”

Medicare 98

Medicare Medicare Doctors Hospitals 98

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

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 94

Governance Medicaid Medicaid Medicare 94

The Health Law Firm

FEBRUARY 20, 2016

Circuit ordered the US District Court for the District of Columbia to reconsider a lawsuit seeking to compel the Department of Health and Human Services (HHS) to meet statutory deadlines for reviewing Medicare claims denials. The district court had decided that judicial intervention was not appropriate in such Medicare administrative cases.

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Hospitals 40

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”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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

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

HIT Consultant

JUNE 6, 2022

Founded in 2014 by former National Coordinator for Health IT, Farzad Mostashari, Aledade began building ACO networks for independent physicians through the Medicare Shared Savings Program, but now also partners with commercial payers across the country. Delivering Value-Based Primary Care.

Medicare 52

Medicare Medicare Doctors 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.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Populi

FEBRUARY 21, 2023

This has been a consistent health consumer sentiment for a long time: here’s how I covered PwC’s study on The Wearable Future back in 2014. ” As employers increasingly pay attention to worker wellness and population health, the enterprise-coverage vision that PwC began to quantify in 2014 is (finally) gaining traction.

Medical Device Industry 62

Medical Device Industry Medicare Medicare FDA 62

Healthcare IT News - Telehealth

SEPTEMBER 19, 2022

in 2014 and 45.5% Reforming Medicare payment. The study, published in Mayo Clinic Proceedings, found that the prevalence of burnout among U.S. physicians was 62.8% in 2021, compared with 38.2% in 2020, 43.9% in 2017, 54.4% The result is that one in five physicians intends to leave their current practice within two years.

COVID-19 143

COVID-19 Doctors Public Health Medicare 143

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

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

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 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare IT Today

JULY 10, 2023

Company Adds Two Board Members and a Senior Executive to Lead its Medicare Advantage Business Aledade , the largest network of independent primary care practices in the country, today announced the closing of a $260 million Series F funding round to enhance and acquire services and technology to support its practices.

Medicare 52

Medicare Medicare Health Outcomes 52

The Health Law Firm

JUNE 4, 2014

The Health Law Firm On June 1, 2015, doctors and other health care providers will be under tighter restrictions when prescribing to Medicare Part D patients. Most health care providers are already enrolled in Medicare. Leider, J.D.,

Medicare 40

Medicare Medicare Medicaid 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

Healthcare Compliance Blog

MARCH 16, 2022

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. and Martech Medical Products Inc.,

FDA 59

FDA Governance Medicare Medicare 59

Healthcare IT News - Telehealth

DECEMBER 17, 2021

According to the indictment , starting in May 2014 the defendants and their co-conspirators allegedly used telehealth to generate prescriptions for compounded medications and durable medical equipment, regardless of medical necessity.

Fraud 127

Fraud Telemedicine Nurses Licensing 127

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. 29844, 29921 (May 23, 2014). CMS’s Payments to MA Plans. at § 1395w-23(b)(4)(D).

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

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

Health Law Advisor

FEBRUARY 3, 2022

billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2021. [1]. With collections amounting to $5.6 billion received in FY 2020.

Fraud 52

Fraud COVID-19 Governance Medicare 52

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 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

Healthcare IT Today

APRIL 21, 2023

Series B funding proceeds will enable Scene to further accelerate its ability to serve Medicaid and Medicare managed care plans, pharmaceutical companies, and clinical research organizations. This financing brings the total investment in Scene to over $25 million since its founding in 2014.

Medicaid 57

Medicaid Medicaid Medicare Medicare 57

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

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. It is not until after this six-month investigation period that the 60 days to report starts to run.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

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

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

Health Populi

APRIL 8, 2019

That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement. The $285K also assumes the couple doesn’t have employer-sponsored retiree health care coverage and qualifies for “Original Medicare” (not Medicare Advantage, for example).

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108