CMS.gov

NOVEMBER 16, 2018

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Director, Medicare-Medicaid Coordination Office, Topic. Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Jeremy.Booth@c…. Fri, 11/16/2018 - 18:51. Tim Engelhardt. Innovation models.

Medicare 35

Medicare Medicare Medicaid Medicaid 35

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Health Outcomes Federal Policy 52

Bill of Health

DECEMBER 27, 2022

High-risk Therapeutic Devices Approved by the US Food and Drug Administration for Use in Children and Adolescents From 2016 to 2021. Variations in Use of Diabetes Drugs With Cardiovascular Benefits Among Medicaid Patients. Pathak K, Narang C, Hwang TJ, Espinoza JC, Bourgeois FT. JAMA Pediatrics. 2022 Nov 7:e224131. Epub ahead of print.

Medicare 144

Medicare Medicare Medicaid Medicaid 144

Compliancy Group

JULY 15, 2022

A 2016 hacking incident that hit Oklahoma State University’s Center for Health Sciences has led to an $875,000 HIPAA breach fine settlement to address potential violations. Hackers first gained access to a web server containing the electronic protected health information (ePHI) of as many as 279,865 individuals on March 9, 2016.

HIPAA 97

HIPAA Medicaid Medicaid Compliance 97

HIT Consultant

APRIL 17, 2024

Ophelia’s Virtual-First Model Increases Access to Treatment In response to this crisis, Pennsylvania established the COE program in 2016. The COVID-19 pandemic and the rise of synthetic opioids like fentanyl have further exacerbated overdose deaths in recent years.

US Department of Health and Human Services 97

US Department of Health and Human Services COVID-19 Licensing Medicaid 97

Jane Sarashon

JANUARY 19, 2024

Elevance Health, the health plan organization comprising XXX plans serving 117 million members, launched a program to channel mobile phones and data plans into the hands of some Medicaid plan enrollees, explained in the organization’s press release on the program.

Medicaid 70

Medicaid Medicaid COVID-19 Health Outcomes 70

Electronic Health Reporter

JANUARY 3, 2019

On December 2016, the 21st Century CURES Act was signed into law, resulting in new regulations for the home health industry. The CURES Act mandates the use of electronic visit verification, or EVV, for all Medicaid-funded personal care services. This content is copyrighted strictly for Electronic Health Reporter.

Medicaid 128

Medicaid Medicaid 128

The Health Law Firm

MAY 31, 2016

Board Certified by The Florida Bar in Health Law On May 9, 2016,Michael John Veit, 64, the former chief procurement officer for Arizona's state Medicaid program, was sentenced to 10 years in prison for his role in the fraud scheme that resulted in the theft of 5.9 By George F. Indest III, J.D., million dollars.

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Medicaid Medicaid Fraud 40

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.,

Medicaid 40

Medicaid Medicaid Nurses Fraud 40

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. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

The Health Law Firm

SEPTEMBER 19, 2016

Board Certified by The Florida Bar in Health Law On August 11, 2016, a former dentist in Connecticut and his practice were ordered to pay more than $700,000 in restitution and civil penalties for improperly billing the state Medicaid program for pediatric dental cleanings and fluoride treatments. A Scheme to Improperly Bill Medicaid.

Medicaid 40

Medicaid Medicaid 40

Bill of Health

NOVEMBER 17, 2022

Fulfillment of Postmarket Commitments and Requirements for New Drugs Approved by the FDA, 2013-2016. Medicaid Spending on Antiretrovirals from 2007-2019. Brown BL, Mitra-Majumdar M, Darrow JJ, Moneer O, Pham C, Avorn J, Kesselheim AS. JAMA Intern Med. 2022 Oct 3:e224226. Epub ahead of print. Califf RM, Cavazzoni P, Woodcock J.

FDA 184

FDA World Health Medicaid Medicaid 184

The Health Law Firm

MARCH 18, 2016

Board Certified by The Florida Bar in Health Law On March 9, 2016, authorities in Florida arrested a Kissimmee couple accused of Medicaid fraud. are accused of fraudulently billing Medicaid for more than $180,000 worth of mammography services never rendered. Indest III, J.D., and Medisound, Inc.,

Fraud 40

Fraud Medicaid Medicaid 40

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 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.

Medicaid 40

Medicaid Medicaid Fraud 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

HIT Consultant

SEPTEMBER 18, 2023

The newest value-based payment program purposely designed to address SDOH is the ACO Realizing Equity, Access, and Community Health (ACO REACH) model, launched by the Centers for Medicare & Medicaid Services (CMS). Since 2016, Z codes have been available to capture SDOH data at the point of care delivery.

Health Outcomes 114

Health Outcomes Electronic Medical Records Medicaid Medicaid 114

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. Indest III, J.D.,

Nursing Homes 40

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

HIPAA Journal

SEPTEMBER 11, 2023

In 2016, a media outlet reported that members of the health plan were able to access the protected health information (PHI) of other members via the online member portal over a 2-day period in 2014 due to a manual processing error. Care Health Plan it had initiated a compliance review and in February 2016, L.A. OCR informed L.A.

HIPAA 76

HIPAA Compliance Medicaid Medicaid 76

Healthcare Law Blog

SEPTEMBER 6, 2023

On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited proposal to establish new federal minimum staffing standards for long-term care facilities. [1] 68754 (October 4, 2016). 55 RN hours per resident per day (the “.55 55 RN HPRD”); and At least 2.45 Nurse Aide (NA) HPRD (the “2.45

Nursing Homes 98

Nursing Homes Nurses Medicaid Medicaid 98

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.

Fraud 40

Fraud Medicaid Medicaid Medicare 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. Health Populi’s Hot Points: U.S. households.

ACA 133

ACA Health Insurance Medicaid Medicaid 133

HIPAA Journal

JULY 15, 2022

The information exposed and potentially obtained by an unauthorized third party included names, Medicaid numbers, healthcare provider names, dates of service, dates of birth, addresses, and treatment information. 164.502(a).

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HIPAA Compliance Medicaid Medicaid 129

HIPAA Journal

FEBRUARY 16, 2022

The PHI of non-dental patients who received healthcare services between December 5, 2016, and August 31, 2020, was also compromised and included names, birthdates, addresses, insurance identification numbers, and Social Security numbers.

Ransomware 127

Ransomware Hospitals Licensing HIPAA 127

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.

Fraud 40

Fraud Medicaid Medicaid Doctors 40

Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Healthcare Compliance Blog

APRIL 29, 2022

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. in restitution for her role in healthcare fraud, wire fraud, and theft of government funds.

Fraud 59

Fraud Compliance Governance Medicaid 59

CMS.gov

JUNE 25, 2019

The Medicaid program has grown from $456 billion in 2013 to an estimated $576 billion in 2016, largely fueled by a mostly federally financed expansion of the program to more than 15 million new working age adults.

Medicaid 46

Medicaid Medicaid 46

MedTrainer

MARCH 3, 2021

The Physician Quality Reporting System (PQRS) was first introduced over a decade ago by the Centers for Medicare and Medicaid Services (CMS) as a quality reporting program. In 2016, Healthcare providers who successfully participated in this program were listed on the new public Physician Compare webpage. What does PQRS involve?

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

OCTOBER 5, 2023

More than 400 hospitals have closed their L&D units between 2016-2020. where women face challenges with access to care, where health systems are struggling to keep L&D departments open, and where high Medicaid populations exist. Despite spending $111 billion on maternity care annually, mortality rates in the U.S.

Health Outcomes 52

Health Outcomes Hospitals Medicaid Medicaid 52

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

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. Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

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.

HIPAA 73

HIPAA Governance Medicaid Medicaid 73

Provider Trust

JULY 26, 2023

The Centers for Medicare and Medicaid Services (CMS) conducted multiple reviews of Medicaid Advantage provider directories between February 2016 and July 2018. However, Medicaid Advantage plans aren’t alone in this problem. Unfortunately, provider directories are often riddled with inaccuracies.

Medicaid 52

Medicaid Medicaid Compliance Medicare 52

Healthcare Law Blog

MARCH 20, 2023

The Kaiser Family Foundation surveyed forty-four state Medicaid officials about strategies to address behavioral health workforce shortages and found the following four categories to be most critical. [6] 8] State Delivery System and Payment Strategies Aimed at Improving Outcomes and Lowering Costs in Medicaid , Kaiser Family Foundation (Jan.

Medicaid 52

Medicaid Medicaid Licensing ACA 52

Med-Net Compliance

OCTOBER 19, 2022

They agreed to be excluded from participating in Medicare, Medicaid, and all other federal healthcare programs for a period of five years. The whistleblowers also alleged other claims under the False Claims Act and Oklahoma Medicaid False Claims Act. The corporate officers were previously the CEO and COO of the company.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Medicaid 59

The Health Law Firm

MARCH 8, 2016

Board Certified by The Florida Bar in Health Law On February 26, 2016, The Centers for Medicare & Medicaid Services (CMS) extended the deadline for eligible hospitals/professionals and critical access hospitals to apply for a hardship exception from the 2015 Medicare Electronic Health Records Incentive Program. Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40