Bill of Health

JULY 28, 2023

US Food and Drug Administration Review Time of Supplemental New Indication Approvals of Drugs and Biologics, 2017 to 2019. Inflationary Rebates For Generic Drugs Sold Through Medicaid Saved Billions During 2017-20. J Diabetes Sci Technol. 2023 Jun 5:19322968231178016. Epub ahead of print. Dhodapkar MM, Ross JS, Ramachandran R.

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Medicaid Medicaid Governance 130

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

Medicaid 48

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.

Medicare 144

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.,

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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.

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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.

Fraud 95

Fraud Medicaid Medicaid Doctors 95

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%.

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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

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 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.

Medicaid 71

Medicaid Medicaid Health Analytics Governance 71

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

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

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).

HIPAA 123

HIPAA Compliance Medicaid Medicaid 123

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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Nursing Homes Nurses Medicaid Medicaid 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.

Medicare 98

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]

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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

Healthcare Law Blog

MARCH 25, 2022

Then, in July 2018, HHS announced it would republish the previously adopted risk-adjustment rule for the 2017 benefit year. More specifically, for 2017, Vista Health ’s first full year of business, HHS assessed risk-adjustment charges of over $4.3 And for the 2018 benefit year, HHS promulgated a new rule in December 2018.

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ACA US Department of Health and Human Services Health Insurance Medicaid 52

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts.

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

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 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.

Medicaid 202

Medicaid Medicaid COVID-19 Telemedicine 202

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

HIT Consultant

DECEMBER 20, 2021

The Partners, complemented by a team of private equity professionals, have successfully invested together since 2017, with approximately $700 million of funds committed and a track record of 11 portfolio companies.

ACA 52

ACA Medicaid Medicaid Medicare 52

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

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

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.

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COVID-19 Health Outcomes Medicaid Medicaid 98

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

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.,

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Overpayments Overpayment Medicaid Medicaid 40