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. As we predicted in February , this Final Rule is now being challenged in court.

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Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS.

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Medicare Medicare Overpayments Overpayment 52

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment. in June 2022. payment update.

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Medicare Medicare Payment Systems Governance 52

Provider Trust

JANUARY 26, 2022

Let’s start with the role of the OIG, which is tasked with ensuring that dollars for federal healthcare programs such as Medicare, Medicaid, CHIPS, and TriCare, as well as other healthcare federal grant monies, are judiciously spent and awarded as reimbursements for quality care that is not fraudulent. So what are the risk categories?

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

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. The proposed regulation 45 C.F.R.

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Health Populi

OCTOBER 17, 2019

points in 2018 to 57.9 Even with that growing time spent on research, compared with studying other consumer good investments — like buying a TV or a car, choosing a mobile phone company, or booking travel — consumers spend much less time seeking information on health care services, shown in the third chart. households.

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Health Insurance Medicare Medicare Governance 58

Provider Trust

MAY 18, 2022

If the answer is yes, then the best mechanism for limiting CMP liability is to screen all persons that perform under that contract or that are in that job category. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency. The defendants settled and paid $19.95

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