Health Care Law Brief

FEBRUARY 2, 2024

While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Electronic Health Reporter

APRIL 7, 2020

The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided […].

Medicare 79

Medicare Medicare COVID-19 Medicaid 79

Healthcare IT News - Telehealth

NOVEMBER 27, 2019

2019: Year in Review It's been an eventful year for health IT. As we look back on 2019, it's worth remembering how far the industry has traveled to get here. -- Mike Miliard, Editor. by Healthcare IT News November 22, 2019. by November 18, 2019. by September 30, 2019. by September 01, 2019.

Telemedicine 85

Telemedicine Health Analytics Governance Hospitals 85

Health Law RX

FEBRUARY 15, 2023

Medicaid providers and suppliers have likely discovered this the hard way. A provider’s or supplier’s enrollment in the Medicaid program may be insufficient to assure that their provision of a covered and medically necessary good or service to a Medicaid patient will be deemed reimbursable. First, get the word out.

Medicaid 52

Medicaid Medicaid Health Care Lawyers Compliance 52

Mobi Health News

JULY 12, 2018

The Centers for Medicare and Medicaid Services released its new proposed Physician Fee Schedule and Qualified Payment Program updates for 2019, and the announcement includes some big strides forward in promoting digital health technology, including widened telemedicine coverage, an overhaul of documentation requirements, and a new focus on interoperability. (..)

Telemedicine 67

Telemedicine Medicaid Medicaid Medicare 67

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). Indest III, J.D., Background Info.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. The total amount of the penalties is determined by how much each hospital bills Medicare.

Medicare 123

Medicare Medicare Hospitals COVID-19 123

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Healthcare IT News - Telehealth

OCTOBER 21, 2020

Data released this past week from the Centers for Medicare and Medicaid Services show that more than 34.5 million services were delivered via telehealth in Medicare and in the Children's Health Insurance Program from March through June. WHY IT MATTERS. As of June 2020, said CMS, more than 91.8 ON THE RECORD.

Medicaid 205

Medicaid Medicaid Medicare Medicare 205

Hall Render

JULY 18, 2022

The Centers for Medicare & Medicaid Services (“CMS”) has given itself an extra year to review and assess skilled nursing facility proposed regulations issued in 2019. Areas Addressed in 2019 Proposed Rule. Background. Extra Time. The notice extends the timeline to finalize the provisions until July 18, 2023.

Nurses 40

Nurses COVID-19 Compliance Medicare 40

HIPAA Journal

SEPTEMBER 29, 2022

The Government Accountability Office (GAO) recently conducted a review of Medicare telehealth services provided during the COVID-19 pandemic, when a waiver was in place that greatly expanded access to telehealth and virtual visits. Between April and December 2019, 5 million Medicare telehealth visits were conducted.

Medicare 70

Medicare Medicare COVID-19 HIPAA 70

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 52

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]

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT News - Telehealth

JULY 22, 2022

Meanwhile, the Centers for Medicare and Medicaid Services' Center for Program Integrity also announced that it has taken administrative actions against more than 50 healthcare providers alleged to be involved in similar schemes. billion in alleged fraud. healthcare system at the expense of patients."

Fraud 136

Fraud Telemedicine Medicare Medicare 136

Electronic Health Reporter

MARCH 6, 2020

The Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19). This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited.

COVID-19 89

COVID-19 Medicaid Medicaid Medicare 89

McBrayer Law Blog

SEPTEMBER 28, 2021

In April of 2019, the Centers of Medicare and Medicaid Service (CMS) finalized rules to increase telehealth benefits for Medicare Advantage enrollees, effectively incentivizing health systems with high numbers of private Medicare plan recipients to invest in telehealth services.

Telemedicine 64

Telemedicine Compliance COVID-19 Fraud 64

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. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

The Health Law Firm

OCTOBER 31, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. By George F. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare Doctors 40

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

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT News - Telehealth

MARCH 25, 2021

Using data from Blue Health Intelligence data repository – an independent data and analytics company that is a licensee of the Blue Cross and Blue Shield Association – researchers from the Johns Hopkins Bloomberg School of Public Health compared claims data from March through June 2019 with March through June 2020.

COVID-19 203

COVID-19 Public Health Medicare Medicare 203

The Health Law Firm

DECEMBER 30, 2019

Board Certified by The Florida Bar in Health Law For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Med-Net Compliance

SEPTEMBER 23, 2022

A physician pleaded guilty in federal court to falsely certifying that products and tests were medically necessary for more than 2,000 Medicare and Medicaid patients in Missouri whom he never met or examined. The orders that he signed for durable medical equipment for Medicare beneficiaries caused Medicare to be billed more than $6.2

Fraud 59

Fraud Medicaid Medicaid Telemedicine 59

Healthcare Law Today

JANUARY 20, 2022

The Centers for Medicare & Medicaid Services (CMS) has responded to these calls by continuing its efforts to address this epidemic and expand access to mental/behavioral health in its new 2022 Physician Fee Schedule Final Rule. The New Rule and the SUPPORT Act. geographic location, originating site, etc.). What’s next?

Medicare 52

Medicare Medicare COVID-19 Public Health 52

HIPAA Journal

MAY 19, 2022

million settlement proposed by Solara Medical Supplies to resolve a class action lawsuit related to a 2019 data breach has received preliminary approval from the court. The breach was reported to the HHS’ Office for Civil Rights as affecting 114,007 individuals.

Licensing 106

Licensing HIPAA Health Insurance Medicaid 106

Healthcare IT Today

JULY 14, 2021

” Finalized in 2019, the CMS (Centers for Medicare & Medicaid Services) Price Transparency Final […]. This week’s chat will be hosted by Hailey Froisland (@haileyfroisland) on the topic “CMS Price Transparency Rule: Is it Working?”

Medicaid 66

Medicaid Medicaid Medicare Medicare 66

The Health Law Firm

OCTOBER 3, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. By George F. Indest III, J.D.,

Fraud 40

Fraud Doctors Medicare Medicare 40

Bill of Health

NOVEMBER 17, 2022

Medicare’s National Coverage Determination for Aducanumab – A One-Off or a Pragmatic Path Forward? Medicaid Spending on Antiretrovirals from 2007-2019. 2022 Oct 5;379:e071752. Dhruva SS, Ramachandran R, Ross JS. N Engl J Med. 2022 Oct 27;387(17):1539-1541. Epub 2022 Oct 22. Feng K, Kesselheim AS, Russo M, Rome BN.

FDA 184

FDA World Health Medicaid Medicaid 184

Healthcare Law Today

NOVEMBER 9, 2022

Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” Background and History of Medicare Telehealth Coverage of SUD Treatment. New Changes to Medicare OTP Telehealth Services.

Medicare 52

Medicare Medicare COVID-19 Telemedicine 52

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

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

Nursing Homes 59

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

HIT Consultant

FEBRUARY 16, 2022

Founded in 2019, with the support of the Mailman School of Public Health at Columbia University, NourishedRx (formerly Project Well) is the first smart, Food-for-Health market platform designed to drive lasting dietary change for health plan members. Personalized Nutrition.

Medicaid 98

Medicaid Medicaid Public Health Medicare 98

HIPAA Journal

JULY 21, 2022

has agreed to settle a class action lawsuit and has created a fund of $425,000 to cover claims from victims of a 2019 data breach that affected almost 70,000 current and former patients. The Methodist Hospitals Inc.

Hospitals 65

Hospitals Licensing HIPAA Medicaid 65

Healthcare IT News - Telehealth

NOVEMBER 2, 2020

Centers for Disease Control and Prevention released Friday found a 154% increase in telehealth visits during the last week of March 2020, compared with the same time period in 2019. " This was 50% higher than the approximately 1 million encounters during the same period in 2019. ON THE RECORD.

COVID-19 190

COVID-19 Medicaid Medicaid Public Health 190

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