Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. See also Ratanasen v.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

HealthStream

DECEMBER 19, 2019

Leaders are looking to optimize software solutions which provide methods to improve efficient communication and required payer ongoing verifications, as well as integration with the Council for Accountable Quality Healthcare (CAQH), State Medicaid, and Medicare enrollment.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

HIT Consultant

NOVEMBER 2, 2023

This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Bill of Health

MARCH 25, 2022

Medicaid Expenditures and Estimated Rebates on Line Extension Drugs, 2010-2018. New EU regulation on health technology assessment of cancer medicines. Lancet Oncol. 2022 Feb;23(2):e58. PMID: 35114127. Hwang TJ, Feng J, Maini L, Kesselheim AS. J Gen Intern Med. 2022 Feb 22. Epub ahead of print. PMID: 35194743.

FDA 205

FDA COVID-19 Medicaid Medicaid 205

Bill of Health

MAY 19, 2022

from 2018-2019. Therapeutic Value Assessments of Novel Medicines in the US and Europe, 2018-2019. A full posting of abstracts/summaries of these articles may be found on our? Aboy M, Liddell K, Jordan M, Crespo C, Liddicoat J. European patent protection for medical uses of known products and drug repurposing. JAMA Oncol.

Health Insurance 205

Health Insurance Hospitals FDA Medicaid 205

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Tue, 10/02/2018 - 15:36. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c…. Seema Verma.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

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. The university announced the HIPAA breach on January 5, 2018.

HIPAA 97

HIPAA Medicaid Medicaid Compliance 97

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. percent in 2018. percent in 2018.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

Fraud 59

Fraud Nursing Homes Medicaid Medicaid 59

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Hall Render

JULY 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. CMS has proposed that 340B hospitals will receive a one-time lump sum payment at the end of 2023 or beginning of 2024.

Hospitals 40

Hospitals Medicaid Medicaid Medicare 40

Kaiser Health News

MARCH 15, 2022

But the new benefit for people enrolled in Medi-Cal, the state’s Medicaid health insurance program, has been delayed twice as the state and doulas — nonmedical workers who help parents before, during, and after birth — haggle over how much they should get paid.

Medicaid 80

Medicaid Medicaid Health Insurance Public Health 80

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. However, Medicaid Advantage plans aren’t alone in this problem. Unfortunately, provider directories are often riddled with inaccuracies.

Medicaid 52

Medicaid Medicaid Compliance Medicare 52

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.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

HIPAA Journal

JULY 15, 2022

OCR launched a HIPAA investigation after receiving a breach report on January 5, 2018, in response to the hacking of an OSU-CHS web server. OSU-CHS determined that malware had been installed on the server which allowed the hacker(s) to access the electronic protected health information of 279,865 individuals.

HIPAA 144

HIPAA Compliance Medicaid Medicaid 144

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). 2018), rev’d in part on other grounds sub nom. FOOTNOTES. [1] 1] See UnitedHealthcare Ins. Azar , 330 F. 3d 173 (D.D.C. Becerra , 16 F.4th

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

HIT Consultant

APRIL 3, 2023

Progress toward VBC adoption hasn’t achieved its potential yet, hovering around 60% of all payment models from 2018 to 2021, with the remaining 40% comprised of traditional fee for service (FFS).

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. As part of the settlement, the doctor will pay a total of more than $9.48

Fraud 59

Fraud Doctors Elder Abuse Medicare 59

Healthcare Compliance Blog

JANUARY 14, 2022

Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. The United States alleges that between 2013 and 2018 the shoe company sold diabetic shoe inserts that were represented to be custom made for an individual’s foot but were actually made using generic foot models.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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 Errors identified in already completed audits will be extrapolated more aggressively for audits going back to 2018, and then going forward for new audits. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

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

Health Populi

DECEMBER 4, 2019

With new rules emanating from the White House this month focusing on health care price transparency, health care costs are in the spotlight at the Centers for Medicare and Medicaid Services. Read my post on getting transparent about transparency in Medecision’s blog here for more details and a deeper dive into this important issue.

Medicaid 83

Medicaid Medicaid Medicare Medicare 83

Healthcare IT News - Telehealth

OCTOBER 19, 2020

In the suit, the EHR giant argues that it has used the CarePort trademark since 2013 and that in 2018 the telemedicine company changed its name from ER at Home to CarePortMD. In 2018, CarePort Health took over management of AllScripts' Care Management technology to aid with acute-case management and post-acute referrals.

Telemedicine 113

Telemedicine Medicaid Medicaid Hospitals 113

HIT Consultant

AUGUST 5, 2022

Predictions regarding Home Care and Medicaid Outlook: As a general observation, Stout thinks that many states will increase reimbursement rates and funding for Medicaid recipients, who have often had difficulty accessing quality home care due to providers declining to participate in government-funded programs.

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 98

Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

ACA 105

ACA Medicaid Medicaid Compliance 105

The Health Law Firm

SEPTEMBER 25, 2018

Board Certified by The Florida Bar in Health Law On August 22, 2018, a doctor received a sentence of one year and a day in prison from a New York federal court for his part in a $30 million scheme to defraud Medicare and the state Medicaid program. Indest III, J.D.,

Fraud 40

Fraud Doctors Medicaid Medicaid 40

HIT Consultant

MARCH 15, 2023

A June 2022 report from Medicaid and CHIP Payment and Access Commission (MACPAC) further illuminated the issue, explicitly citing an extension of the financing through state Medicaid programs to drive health IT adoption as a decisive step to addressing gaps in access, outcomes data, and oversight.

Medicaid 98

Medicaid Medicaid Doctors 98

The Health Law Firm

OCTOBER 31, 2019

billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice medicine. The vast fraud scheme totaled $2.1 This appears to be a new national record.

Fraud 40

Fraud Medicare Medicare Doctors 40

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. Notably, since 2018, mental health has been the top clinical indication to receive investment, growing from $1.4 billion that year to $5.1 billion in 2021, according to Rock Health.

Medicaid 200

Medicaid Medicaid COVID-19 Telemedicine 200

Health Populi

JUNE 27, 2022

The second bar chart illustrates the per member/per month (PMPM) spend for commercially insured workers, showing growth of over 7% from 2018 to 2019, and nearly 7% drop from 2019 to 2020 in the first year of the pandemic. But flat growth is expected for 2022, Castlight forecasts.

COVID-19 121

COVID-19 Health Insurance Medicaid Medicaid 121

Healthcare IT News - Telehealth

JUNE 26, 2020

Throughout 2018 and 2019, Northwell Health piloted small-scale programs in partnership with the Gary and Mary West Health Institute Collaboration to bring medical services virtually to the homes of their patients. "I know their baseline and when they call, I send the [mobile telemedicine technicians] there."

COVID-19 179

COVID-19 Telemedicine Medicaid Medicaid 179

The Health Law Firm

OCTOBER 3, 2019

billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice. The vast fraud scheme totaled $2.1 Fraudulent Orders for Genetic Testing.

Fraud 40

Fraud Doctors Medicare Medicare 40

HIT Consultant

MARCH 7, 2023

According to the AMA , studies conducted in 2018 showed that “most patients only take their medicine as prescribed about half the time and are often reluctant to tell their doctor, while a quarter of new prescriptions are never filled.” It also costs $290 billion annually in increased medical costs.

Doctors 98

Doctors Medicaid Medicaid Governance 98

Health Populi

DECEMBER 19, 2018

mid-terms elections in the first week of November, 2018. Underneath this statistic, it’s important to compare the payor mix of patients delaying care: nearly one-third of people with private, commercial insurance delayed care by 2018; 22% of people enrolled in Medicaid or Medicare put off care. And, 19% of U.S.

Medicaid 84

Medicaid Medicaid Medicare Medicare 84

HIT Consultant

SEPTEMBER 14, 2022

Edifecs prior authorization complies with existing state, federal, and all Centers for Medicare & Medicaid Services prior authorization regulations and will automatically adhere to future regulations. in 2018 to $10.92 8487) aimed at simplifying the prior authorization process.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

The Health Law Firm

SEPTEMBER 24, 2018

Board Certified by The Florida Bar in Health Law On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. By George F. Indest III, J.D., Section 15.5.3

Medicare 40

Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

AUGUST 10, 2018

Board Certified by The Florida Bar in Health Law On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment policies, payment rates, and quality provisions for services rendered under the Medicare Physician Fee Schedule (PFS). By George F. Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40