Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co. 3d 173 (Sep.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

YouCompli

NOVEMBER 1, 2023

As compliance officers, we are continually placed in a position to influence the actions of others and help shape our organization’s compliance culture. One way to change that perception is to avoid creating “gotcha” moments when you’re working on a compliance-related matter. Here are four tips that will help.

Compliance 52

Compliance US Department of Health and Human Services Compliance Officers Overpayments 52

Healthcare Compliance Blog

APRIL 14, 2022

The OIG audit period was between October 1, 2016, and September 30, 2018. an overpayment), make all reasonable efforts to determine if the skilled level of care is appropriate before submitting a claim to Medicare. To avoid a “reverse false claim” (i.e.,

Medicare 59

Medicare Medicare Overpayments Overpayment 59

Healthcare Compliance Blog

JUNE 9, 2022

In March of 2022, in a related matter, the man pleaded guilty to Healthcare Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the US Department of Health and Human Services between 2016 and 2020. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Healthcare IT Today

MAY 5, 2023

Department of Health and Human Services (HHS) analysis showed Medicare payments for genetic testing quadrupled from 2016 to 2019. Now, as new genetic tests unlock advancements that can improve health and well-being—even for those suffering from the rarest of genetic conditions—the risk for fraud, waste and abuse in genetic testing is high.

Fraud 61

Fraud Medicare Medicare Overpayments 61

CMS.gov

NOVEMBER 16, 2018

These improper payments may be overpayments or underpayments and do not necessarily represent expenses that should not have occurred. This is the second consecutive year the rate has been below the 10 percent threshold for compliance established in the Improper Payments Elimination and Recovery Act of 2010. . billion from 2016 to 2018.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Florida Health Care Law Firm

DECEMBER 2, 2021

Between 2016 and 2020, the OIG resolved 330 SDP cases through settlements, releasing all disclosing parties from exclusion with no integrity measures. They believe that good faith disclosure of potential fraud and cooperation with OIG’s review and resolution process are indications of a robust and effective compliance program.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40