Health Populi

MARCH 8, 2018

Amazon is planning to extend Prime subscriptions to people enrolled in Medicaid for the discount price of $5.99 Medicaid enrollees who want to take advantage of the deal must provide Amazon with a scan or image of the card they use for their benefit (either Medicaid or EBT). a month instead of the recent price increase to $12.99/month

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Medicaid Medicaid 48

HIT Consultant

APRIL 12, 2023

Founded in 2017, 1upHealth’s FHIR®-native platform designed for interoperability and modern computing is used by over 75 enterprise organizations including leading national and regional health plans, the highest performing CMS ACOs, international clinical research organizations, and over 20 state Medicaid agencies.

Medicaid 98

Medicaid Medicaid 98

Bill of Health

MARCH 24, 2023

Assessment of FDA-Approved Drugs Not Recommended for Use or Reimbursement in Other Countries, 2017-2020. Market dynamics of authorized generics in Medicaid from 2014 to 2020. Pham C, Le K, Draves M, Seoane-Vazquez E. JAMA Intern Med. 2023 Feb 13:e226787. Epub ahead of print. Rome BN, Gunter SJ, Kesselheim AS. Health Serv Res.

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Medicare Medicare Medicaid Medicaid 144

The Health Law Firm

AUGUST 14, 2017

Board Certified by The Florida Bar in Health Law On August 3, 2017, the Centers for Medicare & Medicaid Services (CMS) approved a five-year extension of Florida’s Managed Medical Assistance (MMA) section 1115 demonstration. Tools For More Effective Medicaid Programs. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

NOVEMBER 8, 2017

Board Certified by The Florida Bar in Health Law A Michigan dentist accused of Medicaid fraud was recently captured in the Dominican Republic after evading charges for months, state authorities announced. By George F. Indest III, J.D., 27 Charges. 27 Charges. million over a three year period of time.

Fraud 40

Fraud Medicaid Medicaid 40

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

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Fraud Medicaid Medicaid Doctors 110

HIT Consultant

MARCH 22, 2022

What You Should Know: – Cityblock Health, a value-based healthcare provider for Medicaid, dually-eligible and lower-income Medicare beneficiaries appoints co-founder Dr. Toyin Ajayi to CEO. Since launching in 2017, Cityblock has established itself as an industry leader in value-based care for marginalized populations.

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Medicaid Medicaid Medicare Medicare 98

HIT Consultant

OCTOBER 31, 2023

What You Shoud Know: – Medicaid prospective payment rate for Michigan’s federally qualified health centers (FQHCs) has not kept pace with the actual costs incurred to provide healthcare, resulting in a substantial reimbursement gap of $97.95 and indirect costs rising by 26.2%.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Compliancy Group

JULY 15, 2022

The information accessed included patient names, Medicaid numbers, healthcare provider names, dates of service, dates of birth, addresses, and treatment information. At that time, it was believed that the incident started in November 2017, but later forensic analysis revealed the earlier breach date.

HIPAA 97

HIPAA Medicaid Medicaid Compliance 97

HIT Consultant

NOVEMBER 4, 2021

– Since its 2017 founding, Papa and its Papa Pals have served members in all 50 states, across Medicare Advantage, Medicaid, and employer health plans.

Health Outcomes 97

Health Outcomes Medicaid Medicaid Medicare 97

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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Medicaid Medicaid Fraud Health Outcomes 40

Healthcare IT Today

APRIL 25, 2023

1upHealth’s FHIR®-native platform designed for interoperability and modern computing is used by over 75 enterprise organizations including leading national and regional health plans, the highest performing CMS ACOs, international clinical research organizations, and over 20 state Medicaid agencies.

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Medicaid Medicaid Health Analytics Governance 78

Healthcare IT Today

JUNE 21, 2023

Inflation will push Payers back into the Public Marketplace whether Statewide and Federal Health Exchanges, Medicaid and Medicare Before the pandemic, many payers left statewide health exchanges as they found more ways to become profitable outside of the public market. In the same time period we have seen a large surge in Medicaid enrollment.

Medicare 62

Medicare Medicare COVID-19 Medicaid 62

HIT Consultant

FEBRUARY 1, 2023

What You Should Know: – Based on prevalence estimates from PINC AI™ data during 2017-2022, an estimated 66 million emergency department (ED) outpatient visits and 760,000 inpatient admissions in the U.S. during 2017-2022, creating a substantial economic burden for affected hospitals. – Patients with an OUD diagnosis had 32.5

Hospitals 52

Hospitals Medicaid Medicaid Health Outcomes 52

Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. The woman, 45, pleaded guilty to an amended charge of Reckless Conduct (Class A Misdemeanor).

Nurses 59

Nurses Nursing Homes Licensing Fraud 59

Hall Render

JANUARY 24, 2024

CMS introduced an updated Medicare Cost Report e-Filing system (“MCReF”) and related templates to allow Medicare Part A providers the ability to electronically file to their Medicare contractor supporting documentation in addition to their cost report for fiscal years ending on or after December 31, 2017.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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 144

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

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Medicaid Medicaid Governance Fraud 59

HIT Consultant

FEBRUARY 15, 2022

billion in 2017, is projected to reach more than $8.5 Medicaid, Medicare Advantage). public Medicaid, private PPO, Medicare Advantage). Medicaid seniors), delivered in the way the cohort prefers (e.g., Cogan joined SPH Analytics in 2017 as Chief Commercial Officer. . billion by 2025. – Geographic location.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Natalia Mazina

AUGUST 6, 2022

This allegedly fraudulent scheme resulted in the submission of false claims to federal health care programs, including Medicare and Medicaid. More information on the case: United States et al. Habana Hospital Pharmacy, Inc. 17-CV-80871-KAM, S.D.Fla.,

Governance 52

Governance Medicaid Medicaid Medicare 52

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.

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Medicare Medicare Overpayments Overpayment 98

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

Nursing Homes 52

Nursing Homes Medicaid Medicaid Medicare 52

The Health Law Firm

MARCH 6, 2017

The Health Law Firm On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in the Medicare and Medicaid. The provisions of this rule will go into effect on July 13, 2017.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Medisys Compliance

JULY 27, 2022

In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies. These provisions are effective for services furnished on or after January 1, 2011.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

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. Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Healthcare IT News - Telehealth

MARCH 18, 2022

Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. Virtual visits were selected five times more often for anxiety and depression complaints than in-person – and this was for pre-pandemic encounters between 2015 and 2017.

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Medicaid Medicaid COVID-19 Telemedicine 200

Hall Render

DECEMBER 8, 2023

Tower has paid nearly $5M in property taxes since it acquired the hospital in 2017. The Pennsylvania Supreme Court declined to hear Tower Health’s appeal of its loss of property tax exemption for Phoenixville Hospital. Separately, the Supreme Court will still hear Tower’s appeal of its Pottstown Hospital exemptions.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Med-Net Compliance

JUNE 15, 2022

in October 2017?under Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Under the civil False Claims Act, each instance of an item or a service billed to Medicare or Medicaid counts as a claim, so fines can add up quickly. The doctor?is?an

Fraud 59

Fraud Doctors Elder Abuse Medicare 59

Healthcare IT Today

JULY 14, 2022

Is the algorithm in question used for Medicare, Medicaid, or ACA populations? Sachin Patel joined Apixio in 2017 as Chief Financial Officer and later served as President and Chief Financial Officer before taking his current role as Chief Executive Officer. Health coverage program. ” About Sachin Patel.

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ACA Hospitals Medicaid Medicaid 128

Health Populi

FEBRUARY 14, 2018

Focusing in on the health insurance line item, 44% will be covered by private/commercial payors and 51% by Medicare and Medicaid (the remaining 5% of insurance costs will lie with other third-party payors and programs). per year, 2017-26, expected to hit $5.7 What are those “fundamentals” pushing up healthcare spending?

Health Insurance 79

Health Insurance Medicare Medicare Medicaid 79

HIT Consultant

AUGUST 17, 2021

In 2018, 36% of spending was via alternative payment models and by 2025, CMS has targeted 100% of Medicare and 50% of Commercial and Medicaid spending.4 Founded in 2017, ClosedLoop’s healthcare data science platform is purpose-built and dedicated to healthcare.

COVID-19 98

COVID-19 Health Outcomes Medicaid Medicaid 98

The Health Law Firm

FEBRUARY 20, 2018

Board Certified by The Florida Bar in Health Law On December 22, 2017, Kmart Corporation agreed to pay $32.3 The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said. Indest III, J.D.,

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

Pharmacy Law Blog

MARCH 13, 2018

On December 4, 2017, a Florida federal judge refused to dismiss the federal government’s False Claims Act (FCA) suit against a compounding pharmacy. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. December 4, 2017). December 4, 2017). By George F.

Fraud 52

Fraud Governance Licensing FDA 52

Healthcare IT News - Telehealth

JULY 19, 2019

Expansion of telehealth coverage and reimbursement at the state level has grown since 2017, according to the latest American Telemedicine Association. "The progress at the Federal level helps drive state action."

Telemedicine 125

Telemedicine Medicaid Medicaid HIPAA 125

Healthcare Compliance Blog

MAY 9, 2022

It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.?Under A home health services company headquartered in Kentucky, and its related entities, paid $2.1 Issue: All submitted claims must be accurate and truthful.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Compliance 59

Med-Net Compliance

AUGUST 18, 2022

In 2017, a former employee of a hospice services company doing business with the nursing home provider filed a sealed civil complaint or “whistleblower” lawsuit under the False Claims Act in the United States District Court for the Southern District of Indiana. Issue: All submitted claims must be accurate and truthful.

Nursing Homes 59

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

HIPAA Journal

NOVEMBER 3, 2022

The breach involved names, Social Security numbers, dates of birth, driver’s license numbers, financial account information, health insurance policy numbers, medical record numbers, Medicaid/Medicare IDs, and health information, including diagnosis and treatment information. Massengale Eye Care Affected by Eye Care Leaders’ Data Breach.

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HIPAA Health Insurance Licensing Medicaid 68