Kaiser Health News

DECEMBER 23, 2021

President Joe Biden’s top health advisers credited the increased government subsidies, which lowered out-of-pocket costs, for the surge in enrollment. Some of the largest increases are in Florida, Texas, Georgia and nine other states that have not expanded Medicaid under the Affordable Care Act. 1 and ends Jan. ” The 13.6

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Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. US Attorney Ashley C.

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Fraud Compliance Governance Medicaid 59

HIT Consultant

JUNE 7, 2023

In 2016, the Golden State began its Whole-Person Care (WPC) pilots at the county level integrating physical health, behavioral health, and social services for complex needs Medicaid enrollees. billion (about $42 per person in the US) per year after paying for the cost of food with most savings occurring within Medicare and Medicaid.

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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.

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Nursing Homes US Department of Health and Human Services Medicaid Medicaid 40

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. One-half of U.S. Health Populi’s Hot Points: U.S. households.

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Hall Render

AUGUST 8, 2022

The web server contained ePHI, including patients’ names, Medicaid numbers, health care provider names, dates of service, dates of birth, addresses and treatment information. In addition to this breach, the University later reported that a hacker had previously accessed the same web server as early as March of 2016.

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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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Healthcare IT News - Telehealth

APRIL 30, 2021

Questions about the future of telehealth regulations have endured ever since the federal government opted to relax some of them during the COVID-19 pandemic. This isn't the first time a version of the CONNECT Act has been introduced in the Senate; Schatz and Wicker unveiled the initial legislation in 2016. A years-long effort.

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C&M Health Law

MAY 11, 2022

Last week, the Centers for Medicare & Medicaid Services (CMS) released data —for the first time—reporting on mergers, acquisitions, consolidations, and changes of ownership of Medicare enrolled hospitals and nursing homes over the past six years.

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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. Consequently, the best possible defense to such a claim involves disciplined application of clinical guidelines.

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MedTrainer

SEPTEMBER 8, 2023

Advocate Health Care HIPAA Breach (2016) In August 2016, Advocate Health Care Network —one of the largest healthcare systems in Illinois—agreed to settle potential violations of Privacy and Security Rules for $5.55 Details of the settlement indicate the submission of false claims to Medicare, Medicaid, TRICARE, and FECA programs.

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Compliance HIPAA Medicaid Medicaid 52

C&M Health Law

NOVEMBER 7, 2022

CMMI has broad statutory authority not only to test, design, and implement health care payment and delivery models for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) but in certain instances, can implement such models without Congressional action. Potential directions CMMI may take to lower drug costs.

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Medicare Medicare Medicaid Medicaid 52

HIT Consultant

OCTOBER 10, 2023

When Section 1557 came into effect in 2016 under President Obama, it was a testament to the power of health equity as it was designed to support existing legislation like Title VI – the Civil Rights Act of 1964. Carla Fogaren R.N.,

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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. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

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Healthcare Law Blog

MARCH 20, 2023

In light of the behavioral health shortage, and now that these crucial digital health resources have been established, the most looming priority for private and government payors is to address workforce limitations, which directly lead to accessibility limitations for mental health patients. 6] Increase provider reimbursement strategies.

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Medicaid Medicaid Licensing ACA 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

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 Certainly, implementing prospective programs takes time, operating discipline, and analytical prowess, but it can yield improved outcomes as well as reduce downside risk from government audits. million (net) and $4.7

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Kaiser Health News

JULY 11, 2023

Hospitals also claim as community benefits the difference between what it costs to provide a service and what Medicaid pays them, known as the Medicaid shortfall. ” Hospitals have long argued they need to charge private insurance plans higher rates to make up for the Medicaid shortfall.

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MedTrainer

NOVEMBER 20, 2023

Florida Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Florida Department of Health (DOH) plays a crucial role in promoting and safeguarding the wellbeing of Floridians. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

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Compliance Licensing Regulatory Compliance Medicaid 52

Health Law Advisor

APRIL 13, 2023

A point of departure is the guidance in the updated FAQs governing naloxone. Worth noting is that the day after OIG’s publication of the updated FAQs, Robert DeConti, Chief Counsel of the Inspector General, speaking at the AHLA’s Institute on Medicare and Medicaid Payment Issues, offered a few related thoughts.

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Public Health Fraud COVID-19 Medicaid 52

MedTrainer

NOVEMBER 29, 2023

Tennessee Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Tennessee Department of Health (TDOH) plays a vital role in promoting the health and wellbeing of Tennessee residents. TennCare is Tennessee’s managed Medicaid agency.

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Florida Health Care Law Firm

DECEMBER 2, 2021

As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”. But, disclosures must be made in good faith and not done in an attempt to circumvent an ongoing investigation.

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Overpayments Overpayment Fraud Medicare 40

MedTrainer

NOVEMBER 29, 2023

The Executive Office of Health and Human Services administers MassHealth , the state’s Medicaid and Children’s Health Insurance Program (CHIP), providing essential health coverage to low- and moderate-income residents, including families, children, seniors, and individuals with disabilities.

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Compliance Public Health Health Insurance Hospitals 52

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. Supreme Court decision in her case holding that the government could not freeze untainted assets. Innocent” Property Can’t Be Seized. To read more on the U.S.

Fraud 40

Fraud Medicare Medicare Governance 40

AIHC

AUGUST 8, 2023

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

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COVID-19 Governance Hospitals Medicaid 40

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services.

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Medicare Medicare Hospitals Medicaid 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. government can still impose fines for doing business with these companies, even if an organization’s non-compliance was not intentional. However, the U.S.

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ACA Compliance Governance Medicaid 52

HIT Consultant

OCTOBER 4, 2021

The Centers for Medicare and Medicaid Services (CMS) strive for innovations in healthcare technologies that drive down costs and improve the patient experience. One big step forward is the 21 st Century Cures Act passed in 2016, putting patients in charge of their own health records.

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Regulatory Compliance Governance Medicaid Medicaid 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

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

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

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

Health Law Advisor

AUGUST 10, 2023

2] Implementing the 21st Century Cures Act from 2016, regulated CDS software includes that intended to “analyze” “medical information about a patient or other medical information” “for the purpose of supporting or providing recommendations to a healthcare professional about prevention, diagnosis, or treatment of a disease or condition.”

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Healthcare Law Blog

NOVEMBER 21, 2022

Pharmaceutical manufacturers are challenging the breadth of the Federal Anti-Kickback Statute (“AKS”) in federal court, arguing that the government is harming the very vulnerable patients it aims to serve by prohibiting cost-sharing subsidies for life-saving oncology drugs. 23, 2016). [13] 2, 2015). [10] 17, 2022). [11] 13] 67 Fed.

Medicare 52

Medicare Medicare Governance Medicaid 52

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

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

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage. The Proposed Rule specifies the applicable refund methods (e.g.,

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Medicare Medicare Medicaid Medicaid 52

Kaiser Health News

JUNE 16, 2022

” Today, debt from medical and dental bills touches nearly every corner of American society, burdening even those with insurance coverage through work or government programs such as Medicare. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread.

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US Department of Health and Human Services Medical Billing Hospitals Medicare 145

Hall Render

NOVEMBER 17, 2023

Jill Biden will lead new initiative to boost federal government research into women’s health Joint Commission says acute, critical access hospitals must join safety network Lawsuit claims UnitedHealth AI wrongfully denies elderly extended care Most Rural U.S. Compensation is key Is spine surgery expansion next for ASCs?

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