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.

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Medicare Medicare Overpayments Overpayment 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

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 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

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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.

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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

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

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.

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US Department of Health and Human Services Medicare Medicare Hospitals 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. Another factor for device coverage is paying for data processing systems and artificial intelligence services that some products use, in addition to paying for the device itself.”

Medical Device Industry 62

Medical Device Industry Medicare Medicare FDA 62

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.,

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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.

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US Department of Health and Human Services Medicare Medicare Medicaid 59

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

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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

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

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.,

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Medicare Medicare Fraud 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.

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Overpayments Overpayment Medicare Medicare 52

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.

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Fraud COVID-19 Governance Medicare 52

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. For more information, visit scene.health.

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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).

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US Department of Health and Human Services Medicare Medicare Medicaid 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

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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

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.,

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Medicare Medicare Medicaid 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

Health Populi

APRIL 8, 2019

As if that top-line number isn’t enough to sober one up, there are two more caveats: (1) the $285K figure doesn’t include long-term care, dental services and over-the-counter medicines; and, (2) it’s an after-tax number. And, it bears repeating, that no long-term care costs are added into this number. “Be Well.

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108

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

HIT Consultant

FEBRUARY 10, 2022

– The company plans to utilize the funds to grow our team and build on our growing customer traction with Medicare Advantage plans and hospital systems in value-based care delivery contracts. Smart Placement has been proven to allow more elders to get discharged home from the hospital with robust home-based healthcare services.

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Patient Satisfaction Hospitals Health Insurance Nurses 97

Healthcare Compliance Blog

FEBRUARY 15, 2022

This is the second largest annual total in False Claims Act history, and the largest since 2014. Other leading sources include: Combatting the Opioid Epidemic Medicare Advantage Program (Medicare Part C) Unlawful Kickbacks Unnecessary Medical Services Procurement Fraud COVID-Related Fraud Other Fraud Recoveries.

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Fraud Governance Compliance Medicare 59

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.

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Overpayments Overpayment Medicare Medicare 40

HIT Consultant

APRIL 20, 2022

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. 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.

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Medicare Medicare Telemedicine Medicaid 98

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. The public has until 5 p.m.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

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”). and 422.107).

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Medicare Medicare COVID-19 Medicaid 98

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 99

Provider Trust

JULY 26, 2022

District Attorney alleges that Pickering was hired in 2019 as a licensed physician’s assistant at a family practice in Norcross, Georgia but had not been a licensed physician’s assistant in Georgia, or any state, since March 2014. According to the U.S. The Importance of Conducting License Verification and Monitoring. Donna Thiel.

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Licensing Fraud Compliance Nurses 52

The Health Law Firm

JANUARY 2, 2014

Board Certified by The Florida Bar in Health Law On December 12, 2013, the US House of Representatives passed a three-month patch to stabilize physicians’ Medicare payments, delaying a nearly twenty-four percent (24%) cut in Medicare payments that was scheduled for physicians in 2014. Indest III, J.D.,

Medicare 40

Medicare Medicare 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.

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Medicaid Medicaid Fraud Medicare 40

Health Populi

OCTOBER 24, 2022

The second drawing illustrates the fact that health care service patterns have not returned to their pre-pandemic levels. Aside from care for COVID-19, volumes are down except for services related to mental and behavioral health (with rates of mental health prescribing increasing for antidepressant and anti-anxiety drugs). That was 2.7

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COVID-19 Prescription Drug Pricing Health Insurance Health Care Reform 52

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.,

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