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

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.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

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

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

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

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.

Medicaid 91

Medicaid Medicaid FDA Health Insurance 91

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

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 98

Public Health Medicaid Medicaid Health Insurance 98

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 113

Health Insurance Licensing Fraud HIPAA 113

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 95

HIPAA Health Insurance Medicaid Medicaid 95

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.

ACA 138

ACA Health Insurance Governance Medical Billing 138

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 98

Public Health Medicaid Medicaid Electronic Medical Records 98

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

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 106

HIPAA Health Insurance Medicaid Medicaid 106

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

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

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

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 98

Fraud Health Insurance Medicaid Medicaid 98

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

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.

Licensing 96

Licensing Health Insurance Fraud HIPAA 96

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 72

Medicaid Medicaid Health Insurance Licensing 72

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

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

The Health Law Firm Blog

DECEMBER 19, 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

The Health Law Firm Blog

OCTOBER 14, 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

DECEMBER 6, 2023

Considering these substantial consequences for patients’ access to mental health care, developing solutions to prevent ghost networks is critical. Federal legislative solutions The federal No Surprises Act , approved in 2021, mandates that health insurers update the information in their provider directory at least every 90 days.

Governance 144

Governance Medicaid Medicaid Medicare 144

The Health Law Firm Blog

NOVEMBER 7, 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

HIPAA Journal

MAY 16, 2022

Refuah Health Center in New York has recently started notifying 260,740 patients about a security breach that occurred almost a year ago. 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.”

Health Insurance 103

Health Insurance Ransomware HIPAA Licensing 103

Health Populi

JUNE 27, 2022

Declines in preventive care services like cancer screenings and blood glucose testing concern employers, whose continued to cover health insurance for employees during the pandemic. Castlight published the full research findings in April in the company’s 2022 Workforce Health Index.

COVID-19 121

COVID-19 Health Insurance Medicaid Medicaid 121

HIPAA Journal

APRIL 25, 2023

On February 13, 2023, NationsBenefits confirmed that the data compromised in the attack included protected health information such as name, address, phone number, gender, date of birth, health insurance number, medical ID number, Social Security number, date(s) of service, medical device or product purchased, and provider/caregiver name.

Health Insurance 81

Health Insurance Public Health Ransomware Fraud 81

HIPAA Journal

MAY 19, 2022

The settlement has received preliminary approval from the court and a final hearing for the settlement has been scheduled for September 12, 2022. The deadline for submitting a claim is August 8, 2022, and the deadline for objecting to the settlement or requesting to be excluded from the settlement is August 22, 2022.

Licensing 106

Licensing HIPAA Health Insurance Medicaid 106

Healthcare IT News - Telehealth

FEBRUARY 3, 2023

WHY IT MATTERS The bill aims to keep stand-alone telehealth benefits separate, not as a replacement of medical plans, offering them under a group health plan or group health insurance coverage as excepted benefits.

Public Health 167

Public Health COVID-19 Medicare Medicare 167

HIPAA Journal

MARCH 14, 2022

CRMC said at this stage of the investigation it does not appear that the attackers gained access to its electronic medical record database; however, the files accessed or potentially accessed by the attackers included information such as patient names, addresses, birth dates, medical information, and health insurance information.

Electronic Medical Records 128

Electronic Medical Records Health Insurance HIPAA Licensing 128

HIPAA Journal

JULY 28, 2023

The HHS’ Centers for Medicare and Medicaid Services (CMS) is being urged not to implement the proposed standards for prior authorization attachments, as detailed in its December 2022 Notice of Proposed Rulemaking (NPR).

HIPAA 83

HIPAA Health Insurance Medicaid Medicaid 83