Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. the Transactions and Code Sets Rule) and address abuse and fraud in the health care industry to reduce costs to health insurance providers. 7 Billion Lost Each Year to Fraud.

HIPAA 119

HIPAA Fraud Health Insurance Health Care Reform 119

Healthcare IT Today

FEBRUARY 17, 2023

This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. Challenges of Investigating Overpayments Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

Overpayments 87

Overpayments Overpayment COVID-19 Medicare 87

Healthcare IT Today

FEBRUARY 2, 2023

It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. The Justice Department has joined the fraud case against one large national insurer. In the most recent audit , the organization looked at more than 15,000 beneficiaries in the payment year 2021.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

The Health Law Firm Blog

APRIL 21, 2023

Board Certified by The Florida Bar in Health Law On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees. By George F. Indest III, J.D., Accused in an indictment in [.]

Overpayments 40

Overpayments Overpayment Fraud Medicaid 40

Hall Render

DECEMBER 6, 2022

As part of the final regulations released by the Centers for Medicare & Medicaid Services (“CMS”) effective January 19, 2021, CMS finalized a new exception for arrangements where an entity pays a physician less than $5,000 over the course of a calendar year in exchange for items or services. New Exception for Limited Remuneration.

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

The Health Law Firm Blog

JANUARY 24, 2022

Board Certified by The Florida Bar in Health Law On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees. By George F. Indest III, J.D., Accused in an indictment in.

Overpayments 40

Overpayments Overpayment Fraud Medicaid 40

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M health dept. processed 1.5 MASSACHUSETTS High demand is pushing hospitals past their limits, say Southeastern Mass.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

Hall Render

AUGUST 26, 2022

Alaska’s COVID ‘superstorm’ experience of 2021 offers lessons for future pandemics, study says. Charles workers launch petition, refuse to repay overpayments without outside audit; union files BOLI complaint. CHS faces class-action fraud suit. Health care giant to pay Washington $19M to resolve allegations of Medicaid fraud.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40