Natalia Mazina
JULY 3, 2022
For technical and financial reasons, the DHCS has not implemented the new reimbursement methodology until 2019. This lead to overpayments to pharmacies. Only in 2020, it started sending notices of recoupment to pharmacies specifying the amounts owed.
Innovaare Compliance
MARCH 1, 2022
Since 2017, benchmarks have been rising and in 2019, Medicare spent $321 more per person for MA enrollees than it would have spent for the same beneficiaries under traditional Medicare fee-for-service (FFS). 6] Improper payments can be overpayments and underpayments. In fact, spending per enrollee in MA plans is projected to grow 5.3%
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Health Care Law Brief
APRIL 3, 2023
The 2024 Risk Model uses diagnoses from 2018 and costs reflected from 2019 as opposed to the 2020 Risk Model that used 2014 diagnoses and 2015 costs. In the Advance Notice, CMS predicted that the changes to the risk scores and HCC updates will help prevent overpayments by improving the accuracy of payments made to MAOs. See 88 Fed.
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. If a provider identifies billing mistakes in the course of those audits, the provider must repay overpayments to Medicare and Medicaid within 60 days to avoid False Claims Act liability.
Healthcare Law Blog
FEBRUARY 9, 2024
Sherman himself had submitted disclosure logs to the OIG), Sherman alleges that it failed to adequately report the arrangements it had with Neonatology Associates or any other private physician groups, or return any alleged overpayments. 9, 2019) p. 2] District of Delaware | ChristianaCare Pays $42.5 Opening Br.
YouCompli
OCTOBER 26, 2022
In June 2019, the Office of the Inspector General (OIG) released findings and recommendations from a review of polysomnography [sleep] studies. That’s a 41% error rate with an extrapolated overpayment of?$269 Million-Dollar Payback. 269 million.?. The majority of the errors were due to: Incomplete medical record documentation.
Healthcare IT Today
MAY 5, 2023
Department of Health and Human Services (HHS) analysis showed Medicare payments for genetic testing quadrupled from 2016 to 2019. Now, as new genetic tests unlock advancements that can improve health and well-being—even for those suffering from the rarest of genetic conditions—the risk for fraud, waste and abuse in genetic testing is high.
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