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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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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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.

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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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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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CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 billion from 2016 to 2018. percent in 2016 to 35.54 Jeremy.Booth@c….

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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. Some patients treated were allegedly able to walk without assistance and were ineligible for homebound therapy.

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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.”. Some examples include: United Medical Instruments Inc.

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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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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. Actuarial Soundness. Actuarial Soundness.

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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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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.

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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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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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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).

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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).

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Hall Render

NOVEMBER 17, 2023

million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million patients stolen during ransomware attack MINNESOTA CFO of the Year 2023: Penny Cermak, HealthPartners Inc.

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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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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.

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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.

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CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. percent from 2011-2016, from $17.6

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