Healthcare It News

OCTOBER 31, 2022

"Our combined efforts are expected to demonstrate how best to advance our nation’s technical infrastructure to enable SDOH interoperability as supported by ONC’s United States Core Data for Interoperability (USCDI) Version 2," ONC authors Ryan Argentieri, Samantha Meklir and Jawanna Henry wrote in ONC's HealthITbuzz blog.

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Licensing Health Outcomes Medicaid Medicaid 289

The Health Law Firm Blog

NOVEMBER 18, 2023

Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.]

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Healthcare Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-417836, 2020 CPD ¶ 47 ( Nov.

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Governance Department of Veterans Affairs Medicaid Medicaid 52

Hall Render

JUNE 8, 2023

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

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Medicare Medicare Hospitals Governance 40

The Health Law Firm Blog

AUGUST 23, 2022

Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.].

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Medicare Medicare Hospitals Governance 52

Hall Render

JUNE 16, 2023

The Court’s opinion settles two outstanding questions about the authority of the Government to dismiss FCA actions in which it first declines to intervene but that whistleblowers continue to pursue on the Government’s behalf. The Government and Defendants favored the broadest authority permitted in the D.C.

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Governance Medicare Medicare Hospitals 40

NCG Medical Blog

AUGUST 8, 2022

If your medical practice treats patients covered by Medicare, then you already know there are countless regulations you need to closely adhere to in order to avoid any issues with the government.

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Medicare Medicare Governance Medical Billing 52

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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Fraud Medicare Medicare US Department of Health and Human Services 52

Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). Hall Render blog posts and articles are intended for informational purposes only.

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Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. What are the Key Components of a Successful Governance, Risk, and Compliance (GRC) Strategy? News Medical.

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Governance Compliance Hospitals Regulatory Compliance 40

Health Law Advisor

AUGUST 14, 2023

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

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Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

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MedTrainer

JUNE 15, 2022

When changes are made to government regulations, they have far-reaching effects. This is the case for proposed changes to the Medicare Shared Savings Program, as they’ll impact ACOs in more ways than one if they’re enacted. Beyond just receiving better care, the ACO helps out Medicare beneficiaries in many other ways.

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Health Law RX

AUGUST 10, 2023

et al , the government contends that Teva funded the copays of Medicare patients using Copaxone, a multiple sclerosis drug, through donations to nonprofits running patient assistance programs. Teva in turn allegedly benefited from these donations by increasing the cost of Copaxone to the government. The court disagreed.

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Governance Medicare Medicare Fraud 52

Healthcare Compliance Blog

MARCH 2, 2022

The money laundering scheme involved the submission of false and fraudulent claims to Medicare for medically unnecessary genetic tests and durable medical equipment. Allegedly, between January 2020 and July 2021, the ten Florida defendants referred Medicare beneficiaries for medically unnecessary genetic tests and durable medical equipment.

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Healthcare Law Blog

JANUARY 31, 2023

This blog is the second installment of our Digital Health Trends series. Part 2, which governs the medical records of federally assisted substance use treatment programs. vii] “Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule,” Centers for Medicare & Medicaid Services (Nov. In December 2022, the U.S.

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Health Law Attorney

DECEMBER 18, 2020

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Outpatient Prospective Payment System ( OPPS ) and Ambulatory Surgical Center ( ASC ) Final Rule, which may be accessed here. CMS Administrator Seema Verma indicated there would be less micromanagement from the government regarding such decisions.

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Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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Healthcare Law Blog

APRIL 13, 2022

However, in all states, the NSA governs disputes relating to air ambulance services, not state law. Federal law governs disputes relating to out-of-network services provided by air ambulance providers. Background of the NSA. AB 72 also limits the enrollee’s cost-sharing amount to the enrollee’s in-network rate.

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Governance Medical Billing Licensing Medicare 52

MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. So, what is the difference between provider enrollment and credentialing?

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Licensing Governance Compliance Fraud 52

The Health Law Firm

APRIL 24, 2019

Board Certified by The Florida Bar in Health Law Several genetic testing companies have come into the spotlight for allegations of ripping off Medicare and False Claims Act (FCA) violations. This is part one of a two part blog series. Indest III, J.D., Click here for part two! The Details.

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YouCompli

MARCH 22, 2023

According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare. For example, the government regularly asserts Medicare claims must be “reasonable and necessary for the diagnosis or treatment of an illness or injury.” One red flag is the use of standing orders for definitive UDT.

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Overpayments Overpayment Compliance Medicare 52

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

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MedTrainer

NOVEMBER 14, 2023

In this blog post, we’ll explore the many reasons why healthcare compliance isn’t just important — it’s vital. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. What Is Healthcare Compliance?

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Compliance HIPAA Governance Medicare 52

YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). The inflated charges resulted in inappropriate outlier payments from Medicare.

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

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MedTrainer

JANUARY 12, 2024

In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

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MRO Compliance

JUNE 1, 2022

HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. HEDIS works as a government rating tool. Depending on the score of a health plan, payers may receive considerable Medicare financial incentives if a score exceeds a certain level.

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YouCompli

APRIL 13, 2022

CJ Wolf, MD provides enforcement action summaries for the YouCompli blog. But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. This month’s article looks at beneficiary inducement actions. million dollars.

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Medicare Medicare Governance Compliance 40

Verisys

FEBRUARY 9, 2024

Million Full Story Doctor Agrees to Pay $95,000 to Settle Allegations of Health Care Fraud Full Story Columbia Physician Indicted for False Statements to Medicare Full Story Pharmacist Fraud Current and Former Owners of Center City Philadelphia Pharmacy Agree to Pay Over $4.6

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Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 Managed care now covers more than half of Medicare enrollees and over 80% of Medicaid enrollees.

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Healthcare Compliance Blog

MAY 19, 2022

million to settle allegations that it violated the False Claims Act by submitting false claims to Medicare. The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, the hospital submitted claims to Medicare for Intensive Cardiac Rehabilitation (ICR) services provided to Medicare beneficiaries.?Before

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US Department of Health and Human Services Hospitals Medicare Medicare 59

MedTrainer

FEBRUARY 12, 2024

In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare. What is Healthcare Compliance? Failure to report non-compliance can be used against the provider or organization in such lawsuits.

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Compliance Licensing Governance Fraud 52

MedTrainer

FEBRUARY 1, 2024

We’ll answer that question in this blog along with assessments of a good corporate compliance process. Meet Government Requirements: Some government programs and payers, such as the Centers for Medicare & Medicaid Services (CMS) , require healthcare facilities to have compliance programs as a condition for participation.

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Compliance Fraud Regulatory Compliance Regulations Compliance 52

YouCompli

JULY 12, 2022

Wolf, MD provides enforcement action summaries for the YouCompli blog. In fact, Medicare beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. This was more than two in five Medicare beneficiaries. This month’s article looks at telehealth actions. They submitted over $1.1

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COVID-19 Medicare Medicare Telemedicine 52

Verisys

DECEMBER 5, 2023

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs.

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Governance Licensing Malpractice Medicaid 52