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.

Compliance 52

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

Governance 52

Governance Medicare Medicare Medicaid 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 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

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).

Overpayments 52

Overpayments Overpayment ACA Medicare 52

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.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

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.

Medicaid 52

Medicaid Medicaid Licensing ACA 52

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. and $500.39. [4].

Medicare 52

Medicare Medicare Governance Medicaid 52

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.

ACA 52

ACA Compliance Governance Medicaid 52

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.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

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.

Medicaid 52

Medicaid Medicaid Medicare Medicare 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.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

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.

COVID-19 40

COVID-19 Governance Hospitals Compliance 40

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.

Nursing Homes 52

Nursing Homes Nurses 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

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.

Overpayments 40

Overpayments Overpayment Fraud Medicare 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.

Fraud 52

Fraud Compliance Medicaid 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.

Regulatory Compliance 52

Regulatory Compliance Governance Medicaid Medicaid 52

Kaiser Health News

JUNE 16, 2022

Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread. “The No.

US Department of Health and Human Services 145

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

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.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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?

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

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.”

FDA 98

FDA Licensing Hospitals Medicaid 98

C&M Health Law

NOVEMBER 7, 2022

The EO comes two months after the president signed the Inflation Reduction Act (IRA) which promises to lower the cost of prescription drugs for many Medicare beneficiaries. This is not the first time that the White House will try to leverage CMMI’s testing authority to create models that would lower drug costs in Medicare.

Medicare 52

Medicare Medicare Medicaid 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.

US Department of Health and Human Services 40

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

Bill of Health

MARCH 28, 2023

government had funded the R&D for each of the three patented inventions that are currently blocking generic competition. government has a “paid-up license to practice or have practiced for or on behalf of the United States” the invention “throughout the world” ( 35 U.S.C. As a consequence of this funding, the U.S.

Licensing 261

Licensing Governance Medicare Medicare 261

CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Just another name for a government-run, single payer system. Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? Just another name for a government-run, single payer system. keya.joy-bush@….

Governance 55

Governance Medicare Medicare ACA 55

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.,

Compliance 111

Compliance ADA Informed Consent ACA 111

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.

Hospitals 66

Hospitals Medicaid Medicaid Medical Billing 66

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

Health Insurance 96

Health Insurance ACA Medicaid Medicaid 96

Health Populi

APRIL 27, 2023

I’ll remind all of us that a newly-elected President Trump talked about pharma companies quite critically in TIME magazine’s coverage which I discussed here in Health Populi in December 2016. families with lower incomes, Medicaid, has been operated and co-founded at the State level. health citizen-consumers. .

Pharmaceutical Industry 62

Pharmaceutical Industry Public Health COVID-19 Governance 62

Health Populi

JANUARY 24, 2019

The first chart notes important nuances under the majority support for a national health plan which, in this case, asked whether people favored a plan “sometimes called ‘Medicare for all.'” ” I note that note all national health plan designs would need to be tied to Medicare. from a low of 10.9

ACA 62

ACA Medicare Medicare Health Insurance 62

Drug & Device Law

SEPTEMBER 5, 2023

115 (2016), sent the presumption against preemption, in express preemption cases anyway, into the dustbin of history. [B]ecause The First Circuit held, in Medicaid & Medicare Advantage Products Assn., 115 (2016). governs the disposition of this case. Franklin-California Tax-Free Trust , 579 U.S. 5 (1st Cir.

Medicaid 64

Medicaid Medicaid Medicare Medicare 64