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.

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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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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.

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Healthcare IT News - Telehealth

APRIL 30, 2021

The act would expand coverage of Medicare telehealth services and make some COVID-19 telehealth flexibilities permanent, among other provisions. Access for Medicare beneficiaries. The CONNECT Act would aim to answer at least some of those questions, at least where Medicare is concerned. A bipartisan group comprising half of U.S.

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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.

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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.

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Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

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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. Health Populi’s Hot Points: U.S. households. households.

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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.

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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

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Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

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The Health Law Firm

FEBRUARY 15, 2016

Board Certified by The Florida Bar in Health On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule which eased requirements for health care providers to return overpayments within 60 days to avoid False Claims Act (FCA) liability. By George F. 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. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Click here to read one of my previous blog posts regarding Medicare audits.

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The Health Law Firm

MARCH 9, 2016

Board Certified by The Florida Bar in Health Law On March 1, 2016, the Centers for Medicare and Medicaid Services (CMS) suspended a Florida insurer, Ultimate Health Plans Inc.(UHP), UHP), for posing a “serious threat” to Medicare beneficiaries. Indest III, J.D., A Negative Audit From CMS.

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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.

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Med-Net Compliance

OCTOBER 19, 2022

The settlement resolves allegations that between 2013 and 2020, the company paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients. The corporate officers were previously the CEO and COO of the company.

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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.

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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.

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Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule.

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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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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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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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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. Their report from the third round of reviews found that of the 108 providers selected from 52 Medicare Advantage Organizations (MAO) directories, 48.7%

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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.

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Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. Until the passage of the CURES Act in 2016, MACRA was the most significant legislative overhaul of the U.S. Providers who serve Medicare Part B populations receive financial incentives for participation in MACRA MIPS.

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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

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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Hall Render

SEPTEMBER 28, 2023

Detailed Analysis In 2016, the Centers for Medicare & Medicaid Services (“CMS”) updated its life safety and emergency preparedness regulations in 42 CFR § 483.73 to improve protections for all Medicare and Medicaid beneficiaries, including those residing in nursing homes.

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The Health Law Firm

SEPTEMBER 22, 2016

Board Certified by The Florida Bar in Health Law The Centers for Medicare & Medicaid Services (CMS) is implementing a three-year Medicare Pre-Claim Review Demonstration for Home Health Services in the states of Illinois, Florida, and Texas Michigan and Massachusetts. 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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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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Governance Medicare Medicare Medicaid 52

The Health Law Firm

DECEMBER 21, 2016

Board Certified by The Florida Bar in Health Law On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the US Department of Justice (DOJ) announced.

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The Health Law Firm

JULY 14, 2016

Board Certified by The Florida Bar in Health Law On June 30, 2016, a Florida heart surgeon agreed to pay $2 million and release any claims to $5.3 million in suspended funds allegedly owed to him because of allegations of improperly billing Medicare, Medicaid and TRICARE. Indest III, J.D., The Settlement Agreement.

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The Health Law Firm

JANUARY 11, 2017

Board Certified by The Florida Bar in Health Law On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks.

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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. 2018 Medicare Fee-For-Service improper payment rate is lowest since 2010 Significant progress in saving $4.59B in estimated improper payments for the Medicare Fee-For-Service program.

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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.

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HIT Consultant

APRIL 20, 2022

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. Tom Zaubler, MD, Chief Medical Officer of NeuroFlow.

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