The Health Law Firm

DECEMBER 5, 2017

Board Certified by The Florida Bar in Health Law 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 US Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D.,

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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.

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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.

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The Health Law Firm

FEBRUARY 19, 2016

Board Certified by The Florida Bar in Health Law On February 12, 2016, a Florida ophthalmologist accused of bribing his friend, US Sen. Robert Menendez, said that separate allegations against him for Medicare fraud should be dismissed. By George F. Indest III, J.D.,

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Healthcare Compliance Blog

APRIL 19, 2022

A Mississippi man conspired with other individuals to provide fraudulent statements to Medicare for reimbursements of claims for patient treatment and prescriptions. The events took place between January 2016 through March 11, 2019, during which time the man claimed to be a licensed physician in the state of Mississippi.

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The Health Law Firm

AUGUST 11, 2016

Board Certified by The Florida Bar in Health Law On August 8, 2016, a Pennsylvania hospital accused of overbilling Medicare agreed to settle civil claims with the federal government for $325,000, the US Attorney’s office in Philadelphia announced. By George F. Indest III, J.D.,

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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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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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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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Healthcare Compliance Blog

APRIL 12, 2022

By pleading guilty, the business owner admitted that she willfully failed to deposit the Federal Insurance Contributions Act and Medicare (FICA) taxes and income taxes that were withheld from her employees’ wages. However, instead of forwarding those taxes to the government, she kept them for her business.

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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

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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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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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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.

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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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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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Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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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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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. million in 2016, the final year of President Barack Obama’s administration. A record 13.6 The previous marketplace enrollment record was 12.7 ” The 13.6

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The Health Law Firm

MARCH 21, 2016

Board Certified by The Florida Bar in Health On February 3, 2016, the US District Court for the Eastern District of Michigan denied a motion to suppress all evidence of health care fraud seized by the government pursuant to a search warrant of Naseem Minhas’s home health care agency. By George F. Indest III, J.D.,

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Healthcare IT Today

JUNE 29, 2023

Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage. Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008.

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The Health Law Firm

JULY 12, 2016

Board Certified by The Florida Bar in Health Law On June 24, 2016, Prime Healthcare Services, Inc. Prime), a California-based company whose mission was stated to be turning around struggling hospitals, is alleged to have run a systematic scheme to defraud the federal government. Strategies That Violated Medicare’s Trust.

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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 IT Today

OCTOBER 10, 2022

Changes are afoot in the way insurers and governments pay for the drugs and treatments patients need-and a big part of that change includes a move towards value-based contracting, with prices set based on the outcome of treatments. The following is a guest article by Girisha Fernando, Founder and CEO at Lyfegen.

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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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The Health Law Firm

DECEMBER 20, 2016

Board Certified by The Florida Bar in Health Law On December 14, 2016, owners of an East Texas clinical laboratory who overcharged Medicare for falsified driving mileage bills have agreed to pay the US government $3.75 By George F. Indest III, J.D., million to settle a whistle blower's False Claims Act (FCA) lawsuit.

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Hall Render

JANUARY 21, 2022

The Hospital’s Joint Conference Committee (“JCC”), which was vested with final authority to issue a non-appealable decision, held its final hearing on September 22, 2016. The decision was considered final and was subsequently communicated to the plaintiff days later on September 27, 2016. written letter) on September 27, 2016.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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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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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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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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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].

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Fear not, gentle reader.

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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. 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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