Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. MAOs will be required to remit improper payments identified during RADV audits in a manner specified by CMS.

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Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. Characteristics of Prior Authorization Policies for New Drugs in Medicare Part D.

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Healthcare IT Today

NOVEMBER 26, 2019

UnitedHealthcare has struck a deal with national physician group Privia Health under which it will offer more and better data on patients enrolled in the payer’s Medicare Advantage plans. The agreement builds on the payer’s relationship with Privia’s ACO, which has been in place since 2017.

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Healthcare It News

MAY 25, 2022

In 2017, the U.S. billion in additional associated Medicare spending per year. To support health and wellness, ElliQ offers sleep relaxation exercises, physical activity exercises, in-depth nutrition-related conversations, and medication reminders for each user's unique conditions.

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McBrayer Law Blog

OCTOBER 18, 2021

For reference, the 2017 Guidance can be found here. More > Tags: Centers for Medicare & Medicaid Services , Civil Penalties , CMS , Healthcare Providers , Long-Term Care , Long-Term Care Facilities , Medicare. The accompanying CMP Analytic Tool can be found here.)

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Healthcare Law Today

JANUARY 20, 2022

While the opioid crisis has been a declared public health emergency (PHE) since October 26, 2017, overdose deaths remain at an all-time high and have only been exacerbated by the COVID-19 pandemic. In the 12-month period starting in April 2021, over 100,000 people have died from drug overdoses, a 28.5% The New Rule and the SUPPORT Act.

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Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

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Healthcare IT News - Telehealth

APRIL 21, 2022

According to a press release , the surgeon, 56-year-old Dr. Elemer Raffai, is accused of allegedly submitting false claims to Medicare in exchange for kickbacks from telemedicine companies. Raffai, together with others, is allegedly connected to the submission of approximately $10 million in fraudulent claims to Medicare.

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The Health Law Firm

FEBRUARY 18, 2021

Board Certified by The Florida Bar in Health Law On July 31, 2020, a panel of US Eleventh Circuit Court of Appeal judges upheld a 17-year prison sentence for a Florida ophthalmologist found guilty of Medicare fraud. The three-judge panel rejected an appeal in which Salomon Melgen claimed prosecutors mishandled his 2017 criminal trial.

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The Health Law Firm

AUGUST 31, 2020

Board Certified by The Florida Bar in Health Law On July 31, 2020, a panel of judges of the US Eleventh Circuit Court of Appeals in Atlanta upheld a 17-year long prison sentence for a Florida ophthalmologist found guilty of Medicare fraud. Indest III, J.D.,

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The Health Law Firm

APRIL 7, 2017

Board Certified by The Florida Bar in Health Law On March 2, 2017, an Illinois home health care provider launched a class action law suit against Medicare reimbursement auditor AdvanceMed and the US Department of Health and Human Services (HHS) Secretary Tom Price. Indest III, J.D.,

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HIT Consultant

DECEMBER 20, 2022

Co-founders Hillary Ebach and John Banta created Carallel in 2017 because of their experience caring for their aging parents. Carallel already supports more than 400,000 Medicare Advantage and commercially insured members and their caregivers nationally. Adoption/Traction to Date. Reducing Stress in 90% of Caregivers.

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HIT Consultant

APRIL 11, 2022

Specializing in Medicare Value-Based Care Programs. Vytalize Health started as a Medicare-focused primary care practice in New York in 2014. The company will use the new capital to continue investing in its care delivery infrastructure, partner with Medicare Advantage and commercial plans, and expand its team. Recent Growth.

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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.

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The Health Law Firm

NOVEMBER 6, 2017

Board Certified by The Florida Bar in Health Law On October 12, 2017, federal health officials announced they are dropping a Florida nursing home from the Medicare program after 14 patients died allegedly as a result of the Hurricane Irma emergency. Indest III, J.D.,

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HIT Consultant

DECEMBER 11, 2023

Additionally, sources confirmed that Cigna is exploring the potential sale of its Medicare Advantage business, marking a potential shift in its strategy within the sector. However, the significant overlap in their Medicare businesses, particularly Humana’s dominant position, raised antitrust concerns.

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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. Indest III, J.D.,

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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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The Health Law Firm

MAY 12, 2017

Board Certified by The Florida Bar in Health Law On May 9, 2017, a federal jury found four New Orleans doctors and two others guilty for their participation in a Medicare fraud scheme. million in fraudulent Medicare reimbursements. Indest III, J.D., According to prosecutors the defendants netted more than $13.6

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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. Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients. By George F. Indest III, J.D.,

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Healthcare IT News - Telehealth

MAY 13, 2022

"From September 2017 through December 2019, Luke and Laughlin conspired together and with others to unlawfully enrich themselves by submitting and causing to be submitted false and fraudulent claims to federal healthcare benefit programs," the officials alleged. According to a statement released by the U.S. " WHY IT MATTERS.

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Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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The Health Law Firm

DECEMBER 5, 2017

Board Certified by The Florida Bar in Health Law 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 US Supreme Court decision in her case holding that the government could not freeze untainted assets. By George F. Indest III, J.D.,

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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. The past two years have seen the enrollment numbers surge to 14.5

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HIT Consultant

AUGUST 8, 2022

It also offers in-home health evaluations for Medicare Advantage and other government-run managed-care plans. New York-based private-equity firm New Mountain Capital is an investor in Signify after first backing it in 2017. At the close of its deal this year to buy Caravan Health Inc., for about $3.2 B in 2019.

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The Health Law Firm

JUNE 13, 2017

Board Certified by The Florida Bar in Health Law On May 1, 2017, a federal jury in Michigan found a Detroit-area doctor and owner of a medical billing company guilty of perpetrating a $28 million health care fraud scheme. Indest III, J.D.,

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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.

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Healthcare Compliance Blog

MAY 9, 2022

million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida. Juan Antonio Gonzalez, US Attorney for the Southern District of Florida, stated, “The fraudulent billing of Medicare will not be tolerated.

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Med-Net Compliance

AUGUST 18, 2022

to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. The complaint alleged that the provider had engaged in conduct to defraud the Medicare program. Based on the investigation, the estimated loss to the Medicare program was $2,795,522.33. to the United States.

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The Health Law Firm

NOVEMBER 25, 2019

According to federal prosecutors, the eye doctor billed patients and insurance companies for millions of dollars for surgeries that he never performed from 2010 to 2017. Indest III, J.D., Prosecutors also announced that they will sue his practice, The Eye Associates Group, in civil court under the False Claims Act (FCA). The Indictment.

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HIT Consultant

FEBRUARY 15, 2022

billion in 2017, is projected to reach more than $8.5 Given CMS’ recent decision to double the weight of experience-based quality measures used to calculate Medicare Advantage Star Ratings, harnessing the power of these two types of analytics applications together could become a key determinant of success in 2022 and beyond.

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Healthcare IT News - Telehealth

SEPTEMBER 19, 2022

in 2017, 54.4% Reforming Medicare payment. WHY IT MATTERS. The study, published in Mayo Clinic Proceedings, found that the prevalence of burnout among U.S. physicians was 62.8% in 2021, compared with 38.2% in 2020, 43.9% in 2014 and 45.5% Stopping scope creep. Fixing prior authorization burdens. Reducing physician burnout.

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HIT Consultant

AUGUST 24, 2022

– The Pings rollout delivers real-time admission, discharge, and transfer (ADT) e-notifications for HTA’s 15,000 North Carolina PPO and HMO Medicare Advantage plan members. Furthermore, we’re supporting our organization’s vision to be the leading Medicare Advantage plan dedicated to exceptional, personalized, and caring experiences.”.

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HIT Consultant

FEBRUARY 23, 2024

This agreement builds on the successful results of the Value-Based Agreements Bridges and Highmark entered in January 2022 for Highmark’s Medicare Advantage members and the January 2020 Agreement for the Highmark Wholecare membership. Established in 2017 through a collaboration between Independence Health System, St.

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Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. On January 31, 2023, CMS will begin releasing the results of RADV audits and overpayment demands for payment years 2011 through 2017.

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Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. 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.

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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.,

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