HIPAA Journal

OCTOBER 18, 2022

Chambersburg, PA-based Keystone Health has recently announced that it fell victim to a cyberattack on August 19, 2022, which caused temporary disruption to its computer systems. The forensic investigation revealed the hackers first gained access to its systems on July 28, 2022, with access terminated on August 19.

HIPAA 116

HIPAA Health Insurance Licensing Medicaid 116

Health Populi

JUNE 26, 2023

People love being health-insured, but their negative experiences with health plans create serious burdens on patients-as-consumers. The 2023 Kaiser Family Foundation Survey of Consumer Experiences with Health Insurance updates our understanding of and empathy for insured peoples’ Patient Administrative Burdens (PAB).

Health Insurance 62

Health Insurance Doctors COVID-19 Medical Billing 62

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4

Medicaid 77

Medicaid Medicaid Medicare Medicare 77

The Health Law Firm

NOVEMBER 8, 2022

Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. Indest III, J.D., Louis-based Centene. The Allegations Across Many States.

Medicaid 52

Medicaid Medicaid Health Insurance 52

Bill of Health

FEBRUARY 27, 2023

In administrative law disputes, a critical aspect of public health law, clear statement rules enforce separation of powers. Supreme Court decisions issued in 2021 and 2022 demonstrate this vertical constraint. Under the ACA, for instance, the health insurance exchanges must be implemented by HHS if states do not create them.

Public Health 246

Public Health COVID-19 Medicaid Medicaid 246

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). This option is available for five years and ends on March 31, 2027.

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Medicaid Medicaid ACA Public Health 52

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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Medicaid Medicaid Medicare Medicare 52

Healthcare Law Blog

JANUARY 4, 2023

On December 21, 2022, the Department of Health and Human Services (“HHS”) issued a proposed rule aimed at advancing health equity and mitigating health disparities while minimizing administrative burden.

Health Insurance 52

Health Insurance ACA Medicaid Medicaid 52

C&M Health Law

JANUARY 25, 2023

The Act also did not provide the Department of Labor enforcement authority (which was requested in its 2022 Report to Congress) to issue civil monetary penalties against health plans that it finds are noncompliant with the Mental Health Parity and Addiction Equity Act (MHPAEA).

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Medicaid Medicaid Medicare Medicare 104

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.

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Medicaid Medicaid Medicare Medicare 52

The Health Law Firm Blog

MARCH 14, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. By George F. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. By George F. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Healthcare IT Today

FEBRUARY 26, 2023

Proposed fixes include improved health insurance literacy – which could help could help 3.8 Products DirectTrust saw 72 million transactions per month in 2022 and surpassed 3.7 Georgia-based Augusta University Health chose Biofourmis to help expand its virtual care at home program.

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Medicaid Medicaid FDA Health Insurance 94

The Health Law Firm Blog

FEBRUARY 1, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. By George F. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Bill of Health

SEPTEMBER 9, 2022

As Alison Galvani and her coauthors have shown , the loss of employer-sponsored insurance during the pandemic, as well as background gaps in insurance coverage that existed before COVID-19, accounted for hundreds of thousands of deaths over the last several years.

Public Health 362

Public Health COVID-19 Public Health Professionals Governance 362

AIHC

JANUARY 5, 2022

Written by: Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS As a result of the 2021 Consolidated Appropriations Act, several No Surprises Billing Act regulations went into effect on January 1, 2022, for providers, facilities and air ambulance services.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

Bill of Health

NOVEMBER 9, 2023

Despite the important enactment in 2010 of the Patient Protection and Affordable Care Act (ACA), which increases access to care by expanding Medicaid eligibility and protecting insurance coverage of people with pre-existing health conditions and disabilities, more than 25 million people remain uninsured.

COVID-19 157

COVID-19 Public Health ACA Health Insurance 157

Health Populi

JUNE 22, 2022

states to live in for health and health care are Hawaii, Massachusetts, Connecticut, Washington, Vermont, Rhode Island, and Maryland… Those are the top health system rankings in the new 2022 Scorecard on State Health System Performance annual report from the Commonwealth Fund. The best U.S.

COVID-19 112

COVID-19 ACA Public Health Health Outcomes 112

Kaiser Health News

APRIL 16, 2024

Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. Some consumers were switched multiple times or had duplicative policies.

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ACA Health Insurance Governance Medical Billing 138

HIPAA Journal

OCTOBER 17, 2022

Valle de Sol did not state in its notification letters when hackers gained access to its network, or for how long they had access, but did confirm that the unauthorized activity was detected on January 25, 2022. A comprehensive review was conducted of all files that may have been accessed, which was completed on July 18, 2022.

Health Insurance 115

Health Insurance Licensing Fraud HIPAA 115

HIPAA Journal

OCTOBER 7, 2022

Choice Health was provided with the data of plan members to perform its contracted duties. The database was accessible over the Internet due to a misconfiguration by a third-party service provider and was accessed and downloaded on May 7, 2022. CareOregon Reports August 2022 Mailing Error.

HIPAA 98

HIPAA Health Insurance Medicaid Medicaid 98

HIT Consultant

MARCH 8, 2022

The steep incline in unemployment and fears that millions of people would lose their health coverage drove the declaration of the national public health emergency (PHE) on January 31, 2020. Under the PHE, states must keep Medicaid enrollees continuously covered, irrespective of their circumstances. .

Public Health 96

Public Health Medicaid Medicaid Health Insurance 96

HIT Consultant

JULY 17, 2023

Cessation of PHE telehealth, prescribing, and mental health access exceptions could impact the Medicaid population the most. Twenty-one percent of Medicaid enrollees have mild, moderate, or severe SUD, compared to 16% of commercially insured individuals. And as of the latest data, 7.3% And as of the latest data, 7.3%

Public Health 94

Public Health Medicaid Medicaid Electronic Medical Records 94

HIPAA Journal

MARCH 15, 2023

According to the breach notification, ILS identified suspicious activity within its computer systems on July 5, 2022. Assisted by third-party cybersecurity experts, ILS determined that unauthorized individuals accessed its network between June 30, 2022, and July 5, 2022, and acquired files containing sensitive data.

HIPAA 110

HIPAA Health Insurance Medicaid Medicaid 110

Jane Sarashon

FEBRUARY 28, 2022

household budgets in February 2022, highlighted in a poll from Morning Consult : inflationary spikes for housing, food, and energy, and the COVID-19 Omicron variant forcing health care costs up for some consumers driving medical debt up. in January 2022. in January 2022. across the U.S.; more granularly, $4.83

COVID-19 56

COVID-19 Health Insurance Medicaid Medicaid 56

The Health Law Firm Blog

JANUARY 8, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. By George F. Indest III, J.D.,

Fraud 40

Fraud Medicaid Medicaid Overpayments 40

Bill of Health

MAY 19, 2022

2022 Apr;40(4):465-471. 2022 Apr 1;182(4):418-425. 2022 Apr 1;5(4):e227958. 2022 Apr 15. 2022 Apr 19. 2022 Apr 8;12(4):e058279. Value Health. 2022 Apr 26:S1098-3015(22)00154-1. 2022 Apr 28:e220864. 2022 Apr 1;5(4):e226479. 2022 Apr 5. 2022 Apr 18. Nat Biotechnol.

Health Insurance 205

Health Insurance Hospitals FDA Medicaid 205

Bill of Health

OCTOBER 26, 2022

In the post- Dobbs fight to safeguard reproductive healthcare, a new spotlight has been placed on two existing federal laws: the Health Insurance Portability and Accountability Act (HIPAA) and the Emergency Medical Treatment and Active Labor Act (EMTALA). . In June 2022, the U.S. By Katie Gu. The Guidances. CMS EMTALA Guidance

HIPAA 184

HIPAA Medicare Medicare Medicaid 184

Compliance Now

JANUARY 13, 2022

The Biden Administration recently announced the new out-of-pocket (OOP) limits that will apply to group and individual health plans during the 2023 plan year, as well as the Patient-Centered Outcomes Research Institute (PCORI) Fee for plan or policy years ending on or after October 1, 2021, and before October 1, 2022. This is a $.13

ACA 113

ACA Health Insurance Medicaid Medicaid 113

HIPAA Journal

MARCH 21, 2023

ILS Identified the breach in July 2022 and determined unauthorized individuals had access to its network between June 30, 2022, and July 5, 2022. Affected individuals were offered complimentary credit monitoring services and security measures have been enhanced to prevent further data breaches.

Fraud 102

Fraud Health Insurance Medicaid Medicaid 102

Compliance Now

DECEMBER 28, 2022

Late in the afternoon on December 23, 2022, the Administration issued Affordable Care Act FAQ #56 , and in doing so gave a little holiday gift to all group health plans nationwide. This crosswalk was updated on October 3, 2022, to include National Drug Codes (NDCs) for vaccines.

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Health Insurance Compliance Medicaid Medicaid 100

HIPAA Journal

SEPTEMBER 9, 2022

That process concluded on June 24, 2022. Those emails contained patient information such as names, dates of birth, Social Security numbers, medical information, health insurance information, driver’s license numbers, and state ID numbers.

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Licensing Health Insurance Fraud HIPAA 100

American Medical Compliance

DECEMBER 26, 2023

On December 27, 2020, the United States Congress adopted the No Surprises Act (NSA) as part of the Consolidated Appropriations Act of 2021, which has various provisions to assist in protecting customers against unexpected costs beginning January 1, 2022. The following course highlights the NSA and how it impacts healthcare.

Health Insurance 52

Health Insurance Compliance Medical Billing Medicaid 52

HIPAA Journal

JULY 4, 2023

ARx Patient Solutions Reports Email Account Breach from 2022 The Kansas-based healthcare provider, ARx Patient Solutions, has recently notified the Maine Attorney General about a security breach that has affected 41,116 individuals, including individuals who used the ARx Patient Solutions Pharmacy.

Medicaid 73

Medicaid Medicaid Health Insurance Licensing 73

The Health Law Firm Blog

NOVEMBER 29, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. By George F. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Bill of Health

FEBRUARY 28, 2023

That approach successfully transformed public and private health care — albeit not without challenges for coordination and political resistance — through the Patient Protection and Affordable Care Act of 2010. On September 9, 2021, Executive Order 14043 further required all federal employees to be vaccinated by November 2022.

Public Health 176

Public Health COVID-19 Medicaid Medicaid 176

HIT Consultant

APRIL 30, 2023

Analysing and Addressing Barriers to Healthcare Research shows that public transportation expansions improve access to health care, especially for people covered by Medicaid.

Health Insurance 98

Health Insurance Public Health Medicaid Medicaid 98