Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. The purpose of these audits is to evaluate a plan sponsor’s efforts to prevent, detect, and correct fraud, waste, and abuse (FWA) in the Medicare Part C and Part D programs. or Contact Us. appeared first on Inovaare.

Medicare 52

Medicare Medicare Compliance Public Health 52

Hall Render

JANUARY 11, 2023

Federal Food, Drug, and Cosmetic (“FD&C”) Act – If an app includes a software function that meets the definition of a medical device under section 201(h) of the FD&C Act, the app may be subject to regulatory oversight by the FDA. Hall Render blog posts and articles are intended for informational purposes only.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

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”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 and 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Compliance Blog

JUNE 9, 2022

Those claims were for presumptive and definitive Urine Drug Tests (UDTs) that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Innovaare Compliance

AUGUST 24, 2023

To ensure good stewardship of the Medicare Trust Fund, the Centers for Medicare & Medicaid Services (CMS) perpetually makes changes to improve various aspects of the program – quality of care, health equity and payment methodology, to name a few.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Health Law Advisor

APRIL 10, 2023

This interpretation provided to be difficult to apply in real world situations because while we all might think of Amazon and WalMart as big-box stores, it was not clear what other stores might also fall into this category and present a compliance risk. OIG Advisory Opinion (AO) 23-03 On March 29, 2023, the OIG posted AO 23-03 to its website.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Parts 417, 422, 423, 455, and 460.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. However, the bundling of payment for these services raises compliance concerns for providers who use APPs.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare Law Blog

MAY 11, 2023

Review of the Proposed Arrangement Under Federal AKS At a high level, the OIG concluded that the Arrangement presents a minimal risk of fraud and abuse under the AKS. Second, the Arrangement would benefit patients and the Medicare program by promoting compliance with a recommended screening test. FOOTNOTES [1] 42 U.S.C. 1320a–7b(b). [2]

Medicare 52

Medicare Medicare Fraud Compliance 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

AUGUST 8, 2023

I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA). Use as many as will definitively detail the problem statement.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M operating margin, $1B net gain halfway through its first year Illinois public health officials warn of “rising COVID-19 activity” St. million to Resolve False Claims Act Allegations Michigan Pain Center Owner Pays $6.5M

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

JULY 12, 2023

489.18 (the traditional definitions of CHOW) is necessary to trigger this “36-month rule.” Under 42 CFR § 424.550(b)(1), neither a 100% ownership transfer nor a change that qualifies as a CHOW under 42 C.F.R.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. The CMP Final Rule does not apply to healthcare providers unless they also fit the definition of Developers or HIN/HIEs.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Hall Render

APRIL 6, 2022

Second, the relator pointed out that Pharmacy Benefit Managers (“PBMs”) adopted and incorporated this definition of the “usually and customary” pricing into their agreements with pharmacies. Regarding the PBM’s adoption of this definition, the Court stated that this may not serve as the basis of a fraud claim under the FCA.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Healthcare Law Blog

MARCH 3, 2023

This surge was facilitated, in part, by certain flexibilities authorized by the Centers for Medicare & Medicaid Services in its response to the public health emergency (“PHE”) declared in March of 2020 and which was repeatedly renewed until now. On January 30, 2023, President Joe Biden announced that the PHE would end on May 11, 2023.

Fraud 52

Fraud Nurses Telemedicine COVID-19 52

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. Hospices need to be much more vigilant about compliance.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

New Jersey Healthcare Blog

JULY 22, 2022

Following a thorough review in compliance with Executive Order No. The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. On April 4, 2022, at 54 N.J.R. 13:44F with amendments. On April 4, 2022, at 54 N.J.R. See N.J.A.C. On April 4, 2022, at 54 N.J.R.

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COVID-19 Vaccine Licensing COVID-19 Public Health 40

Hall Render

OCTOBER 20, 2023

Luke’s sign definitive agreement, close in on merger How Mayo Clinic Is Approaching Generative AI Risk Mitigation St. joint venture Hospitalist Companies Agree To Pay Nearly $4.4 We want to know. 1 start as federal regulators give final OK Pfizer to cut costs by $3.5B.

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COVID-19 Vaccine Nursing Homes COVID-19 Nurses 40