Kaiser Health News

APRIL 8, 2022

Prescription drug costs for California’s massive Medicaid program were draining the state budget, so in 2019 Gov. The new Medicaid drug program debuted this January, with a private company in charge. Centene was already a big player in state Medicaid drug programs — but one with a questionable record. SACRAMENTO, Calif.

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Medicaid Medicaid Health Insurance COVID-19 93

C&M Health Law

APRIL 21, 2022

Department of Justice (DOJ) to resolve allegations that it had made donations in order to improperly inflate the funding four of its hospitals received from the federal Medicaid program. Florida Medicaid is administered by the state but jointly funded by both the state and federal governments.

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Medicaid Medicaid Governance Fraud 52

The Health Law Firm

NOVEMBER 17, 2015

The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its 2016 Annual Work Plan (Work Plan) on November 2, 2015, with an effective date of October 1, 2015. The Work Plan also summarizes ongoing areas of regulatory review and indicates areas of focus for the OIG in the upcoming year.

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The Health Law Firm

DECEMBER 24, 2016

Board Certified by The Florida Bar in Health Law On December 7, 2016, Banio Koroma was convicted in a northern Illinois court of falsely certifying elderly patients for in-home care will spend the next three years in prison and be forced to reimburse the government for the $1.5 Indest III, J.D., Paying For His Crimes.

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The Health Law Firm

JULY 15, 2016

Board Certified by The Florida Bar in Health Law On June 15, 2016, A medical diagnostics company owner found guilty of Medicare and Medicaid fraud for billing $8 million for X-rays whose botched analysis by amateurs led to the death of two patients was sentenced in Maryland federal court to 10 years in prison, the US Department of Justice said.

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The Health Law Firm

JANUARY 31, 2016

The Health Law Firm A nurse practitioner from Corinth, Mississippi, turned herself over to the authorities on Friday, January 8, 2016. Tami Bivens-Johnson was indicted on three counts of Medicaid fraud by an Alcorn County Grand Jury. Her Alleged Crimes Against Medicaid. Schriefer, R.N.,

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Medicaid Medicaid Nurses Fraud 40

The Health Law Firm

MARCH 13, 2017

Board Certified by The Florida Bar in Health Law On December 20, 2016, the owner of Millennium Health Care Services (Millennium) must pay the state nearly $7 million in restitution and will spend 10 years behind bars for his role in a scheme to defraud the Medicaid system, according to Louisiana Attorney General Jeff Landry.

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Medicaid Medicaid Fraud 40

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Innocent” Property Can’t Be Seized. To read more on the U.S.

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Fraud Medicare Medicare Governance 40

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Standard Contract Requirements/Coordination of Benefits.

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Hall Render

AUGUST 22, 2023

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. the government alleged a clinical pharmacy manager for a Tennessee Walgreens falsified twelve different patients’ medical records between January 2015 and June 2016.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

The Health Law Firm

MARCH 2, 2016

Board Certified by The Florida Bar in Health Law The owner of a diagnostic imaging company in Maryland is facing life in prison after a federal jury found him guilty on February 17, 2016, of health care fraud. Rafael Chikvashvili, was found guilty of billing Medicare and Medicaid for more than $7.5 Indest III, J.D.,

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Fraud Licensing Medicaid Medicaid 40

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

The Health Law Firm

DECEMBER 12, 2016

Board Certified by The Florida Bar in Health Law Walter Beich, an Illinois pharmacist, pled guilty on November 17, 2016 to defrauding Medicare, Medicaid and several private insurers out of $2.4 By George F. Indest III, J.D.,

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Fraud Medicare Medicare Medicaid 40

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

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Prior to 2016, large vendors controlled the market and monopolized state MMISs.

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Medicare Medicare Medicaid Medicaid 52

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

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Overpayments Overpayment Fraud Medicare 40

The Health Law Firm

JULY 20, 2016

Board Certified by The Florida Bar in Health Law On July 7, 2016, the US Fourth Circuit Court of Appeals dismissed a lower court judgment and remanded to state court a qui tam action alleging certain medical laboratories defrauded Virginia’s Medicaid program. Indest III, J.D.,

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Fraud Medicaid Medicaid 40

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta.

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Nursing Homes Nurses Compliance Medicare 52

Healthcare Law Today

JANUARY 2, 2023

In the 2016 Final Rule , CMS agreed “the 60-day time period begins when either the reasonable diligence is completed or on the day the person received credible information of a potential overpayment if the person failed to conduct reasonable diligence and the person in fact received an overpayment. § 401.305(a)(2).

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Overpayments Overpayment ACA Medicare 52

Provider Trust

MAY 18, 2022

Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. OIG may exclude the provider if certain circumstances regarding the ownership are present.

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Compliance Due Diligence Medicaid Medicaid 52

Health Law RX

JULY 18, 2023

Information Blocking Background In 2016, the 21st Century Cures Act (Cures Act) made sharing electronic health information (EHI) the new normal in healthcare, with the twin goals of encouraging and incentivizing the free flow of patient information among stakeholders and driving efficiencies in healthcare.

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Fraud Compliance Medicaid Medicaid 52

Health Law RX

NOVEMBER 10, 2022

The United States alleged that, between August 1, 2016 and June 30, 2017, Sutter Health fraudulently billed and received reimbursement from government health programs for lab tests that Sutter Health did not itself perform.

Governance 52

Governance Medicare Medicare Medicaid 52

Hall Render

MARCH 29, 2024

James Hospital president NEBRASKA Hospital Medicaid funding bill passes on final reading How Nebraska Medicine used AI to reduce first-year nurse turnover by nearly 50% State auditor exposes questionable handling by DHHS of tens of millions of federal dollars Bill passed to bring in more than $1.4 after cyberattack CHI St.

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Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

CMS.gov

NOVEMBER 16, 2018

Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. percent in 2016 to 35.54

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Hall Render

FEBRUARY 10, 2023

Dunleavy proposes extending Medicaid coverage for new mothers ARIZONA Banner Health pays $1.25M penalty over HIPAA failures from 2016 breach Arizona nursing school at risk of losing accreditation St. billion since pandemic U.S. billion since pandemic U.S. Luke’s Health System says it will lay off workers in Idaho.

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40

Verisys

MARCH 24, 2022

Healthcare facilities receive billions of dollars in federal and state funding through the Affordable Care Act (ACA), Medicare, Medicaid, CHIP, and other programs. In 2016, Alcon Laboratories was slapped with a $7.6 When it comes to healthcare, knowing who you’re doing business with matters.

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ACA Compliance Governance Medicaid 52

Hall Render

NOVEMBER 17, 2023

Million Individuals Affected by MOVEit Hack MARYLAND Adventist HealthCare, Montgomery College form partnership to address need for qualified nursing workforce Harford Memorial Hospital closing set for Feb. million patients stolen during ransomware attack MINNESOTA CFO of the Year 2023: Penny Cermak, HealthPartners Inc. Many more are waiting.

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Nursing Homes Nurses Hospitals Doctors 40

AIHC

FEBRUARY 16, 2024

The article states “An example of this was Wells Fargo in 2016. I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA).

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The article states “An example of this was Wells Fargo in 2016. I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA).

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Hall Render

NOVEMBER 3, 2023

Then Prospect Medical took over. institute focused on health equity Medical providers at D.C.’s Luke’s themed rooms a hit with young patients Mercy reverses auction results; declares University of Iowa winner KANSAS As rural Kansas emergency department announces closure, Gov.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

CMS.gov

NOVEMBER 2, 2018

Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare has a plethora of misaligned financial incentives that work to increase costs for taxpayers and beneficiaries, and create challenges related to fraud and abuse. percent from 2011-2016, from $17.6 CMS BLOG: Medicare for All? keya.joy-bush@….

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Governance Medicare Medicare ACA 55