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OIG audit: Aetna may have raked in $25.5M in MA overpayments in 2015, 2016

Fierce Healthcare

million in overpayments from Medicare Advantage in 2015 and 2016. | million in overpayments from Medicare Advantage in 2015 and 2016. A new federal audit estimates that Aetna may have received at least $25.5 A new federal audit estimates that Aetna may have received at least $25.5

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Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage

Kaiser Health News

A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursing home care, and no way to challenge a denial. But it can have serious repercussions.

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Medicare Advantage Plans Must Follow the Two-Midnight Rule

Hall Render

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. 1395w-22(a) ). d)(2) ).

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10 Charged Over BEC Scams Targeting Medicare, Medicaid, and Private Insurance Programs

HIPAA Journal

million being defrauded from Medicaid, Medicare, and private health insurance programs. According to the FBI, more than $43 billion was lost to these scams between June 2016 and December 2021, and in 2021 alone, the FBI Internet Crime Complaint Center received reports of losses of $2,395,953,296 to BEC scams. million, and $6.4

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Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report

CMS.gov

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Director, Medicare-Medicaid Coordination Office, Topic. Medicare Parts A & B. Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Jeremy.Booth@c…. Tim Engelhardt.

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The CONNECT for Health Act is reintroduced, again

Healthcare IT News - Telehealth

A bipartisan group of legislators has reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act – first introduced in 2016 – to expand opportunities and coverage for telehealth through Medicare. This is the second time the bill has been reintroduced. Mike Thompson (D-Calif.)

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Monthly Round-Up of What to Read on Pharma Law and Policy

Bill of Health

Frequency of Approval and Marketing of Biosimilars With a Skinny Label and Associated Medicare Savings. High-risk Therapeutic Devices Approved by the US Food and Drug Administration for Use in Children and Adolescents From 2016 to 2021. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries.

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