Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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The Health Law Firm Blog

APRIL 23, 2024

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By Carole C. Schriefer, J.D. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

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Health Law RX

SEPTEMBER 14, 2021

Medicare and Medicaid certified facilities will be required to ensure that their employees are vaccinated for COVID-19, the Centers for Medicare & Medicaid Services (CMS) announced on September 9, 2021. The Interim Final Rule will apply to any healthcare facility receiving Medicare or Medicaid reimbursement.

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MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

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HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

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Healthcare IT News - Telehealth

JULY 9, 2020

The Centers for Medicare and Medicaid Services has put together further detailed guidance for how healthcare providers should be documenting and reporting electronic clinical quality measures for telehealth encounters. The 39 telehealth-eligible eCQMs for the 2021 performance period can be found here.

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Healthcare IT News - Telehealth

JUNE 19, 2023

Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

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HIT Consultant

APRIL 16, 2024

What You Should Know: – inVio Health Network and CVS Accountable Care Organization, a division of CVS Health , have announced a collaboration to participate in the new Medicare Accountable Care Organization (ACO) REACH program.

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Healthcare IT News - Telehealth

JANUARY 4, 2021

The following 10 predictions that we have made for the global healthcare will define new ways of rethinking business and growth opportunities in 2021, and will help determine the future direction of the industry. By the end of 2021, about 4 billion COVID-19 vaccine doses will be delivered globally.

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The Health Law Firm Blog

MARCH 26, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

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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.

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Kaiser Permanente

JANUARY 1, 2022

Medicaid and the Children’s Health Insurance Program (CHIP) have served as critical supports to children, pregnant women, parents, seniors, and individuals with disabilities – covering 80 million individuals during the COVID-19 pandemic. Since February 2020, Medicaid enrollment has grown sharply to cover an additional 9.9

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HIT Consultant

DECEMBER 1, 2023

What You Should Know: – Clover Health , a physician enablement company committed to bringing access to great healthcare to everyone on Medicare announced that it has delivered notice to the Centers for Medicare and Medicaid Services (“CMS”) that it will exit the CMS ACO REACH Program at the end of the 2023 performance year.

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Fierce Healthcare

AUGUST 24, 2023

The Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) has saved a net $1.8 billion in 2022 from the Medicare Shared Savings Program, CMS said Thursday. billion in 2022 for accountable care organizations, which is th | Accountable care organizations saved a net $1.8

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HIPAA Journal

MAY 16, 2022

According to the April 29, 2022, notification on the healthcare provider’s website, “We recently discovered unauthorized access to our network occurred between May 31, 2021, and June 1, 2021.” The post Refuah Health Center Alerts 260K Patients About May 2021 Cyberattack appeared first on HIPAA Journal.

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Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. CMS proposes calibrating the RxHCC model for CY 2025 on 2021 diagnoses and 2022 expenditure data from PDE records.

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Healthcare Law Blog

MAY 22, 2023

With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9%

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Med-Net Compliance

JULY 11, 2022

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. HHS-OIG also excluded 1,689 individuals and entities from participation in Medicare, Medicaid, and other federal healthcare programs. In FY 2021, the FBI opened 593 new healthcare fraud investigations.

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Healthcare IT Today

DECEMBER 11, 2020

As 2020 comes to a close, healthcare industry leaders are looking ahead to 2021 with excitement and anticipation. The following is a guest article by Mike Noshay, MSE, Founder and Chief Strategy & Marketing Officer at Verinovum.

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McBrayer Law Blog

APRIL 16, 2021

Posted In Centers for Medicare & Medicaid Services (“CMS”) , Code Enforcement , Medicare In addition to staying up to date on the constantly changing landscape of COVID-19 requirements, healthcare providers must also stay well-informed of industry changes unrelated to the pandemic.

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Healthcare IT News - Telehealth

MARCH 30, 2022

Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic. "Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report.

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Jackson Lewis

DECEMBER 1, 2021

District Court for the Western District of Louisiana has granted a preliminary injunction enjoining the Centers for Medicare and Medicaid (CMS) from enforcing its COVID-19 vaccine mandate nationwide. Louisiana et al. Becerra et al. , 3:12-CV-03970 (W.D. This injunction takes immediate effect.

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The Health Law Firm Blog

JUNE 10, 2023

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D., The doctor argued that the [.]

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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.

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The Health Law Firm

FEBRUARY 14, 2022

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D.,

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Healthcare Law Blog

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] ILOSs must advance the objectives of the Medicaid program.

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Bill of Health

DECEMBER 27, 2022

Frequency of Approval and Marketing of Biosimilars With a Skinny Label and Associated Medicare Savings. High-risk Therapeutic Devices Approved by the US Food and Drug Administration for Use in Children and Adolescents From 2016 to 2021. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries.

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Healthcare IT News - Telehealth

DECEMBER 16, 2020

This is according to a new annual report from research and consulting giant PwC entitled “Top health industry issues of 2021: Will a shocked system emerge stronger?” ” Sixty-eight percent of provider executives surveyed by HRI said they plan to use more care navigators and coordinators in 2021.

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Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. Characteristics of Prior Authorization Policies for New Drugs in Medicare Part D. 2023 Feb 23.

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Healthcare IT News - Telehealth

NOVEMBER 10, 2020

Prepare Now for Anticipated Changes to Medicare and Private Payer Rules. The Centers for Medicare and Medicaid Services (CMS) is expected to issue new rules for telehealth in the release 2021 Physician Fee Schedule later this year. Today, Medicare reimburses for specific services when delivered via live video.

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Healthcare It News

OCTOBER 4, 2022

The Electronic Healthcare Network Accreditation Commission and The CARIN Alliance have partnered to bring both the CARIN Code of Conduct and EHNAC’s criteria review process to health plans, health systems, EHR vendors and others for reporting to the Centers for Medicare & Medicaid Services on their data practices and privacy protections.

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Healthcare IT Today

APRIL 29, 2024

This news builds on the company’s recent momentum, including new and expanded payer partnerships to support Medicaid and Medicare lives and notable results for its award-winning Crisis Care program for individuals with elevated suicide risk.

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The Health Law Firm Blog

MAY 12, 2023

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]

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Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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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. Paradoxically, all those hospitals have five stars, the best rating, on Medicare’s Care Compare website.

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Healthcare Law Blog

MAY 16, 2022

More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. In 2015, DHCS launched the WPC Pilots as part of its Medi-Cal 2020 Section 1115 Demonstration.

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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.

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