Healthcare Law Today

JANUARY 11, 2023

violated the False Claims Act by causing medical providers to submit false claims to Medicare. The lawsuit alleged that the device was not approved or authorized by the FDA and that the procedure was not covered by Medicare. and Martech Medical Products Inc.,

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Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. 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.

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US Department of Health and Human Services Medicare Medicare Overpayments 59

Bill of Health

FEBRUARY 10, 2023

Or an extension of the doctrine of public fraud? The traditional definition of the Police Power is the responsibility of the state to protect “health, safety, morals and general welfare.” What is missing from the revised definition of the police power is the responsibility to take moral action to protect the public.

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Health Care Law Brief

JUNE 20, 2023

The District and the Seventh Circuit Endorsed a Pure Objective Reasonableness Standard for FCA Scienter In this case, the relator alleged that certain pharmacies, among other things, misreported their pricing of certain drugs covered by Medicare and Medicaid.

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Healthcare Law Blog

MAY 11, 2023

THE OIG’S ANALYSIS: The OIG advised that the Arrangement would implicate the Beneficiary Inducements CMP and AKS because of the offer and transfer of remuneration to Medicare patients, potentially resulting in the purchase of laboratory services in connection with the Test.

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Compliancy Group

JANUARY 3, 2024

This is why a regular review of these contracts is essential so that providers and administrators can clear up uncertainties in the terms or conditions, remain compliant, and ensure the payer is engaging in fair practices.

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Health Law Advisor

APRIL 10, 2023

This distinction is relevant for applying the Preventive Care Exception to the Beneficiary Inducements CMP and may allow for a greater variety of incentives to be given to Medicare and Medicaid beneficiaries when the other requirements of that exception are met.

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Med Com Blog

JANUARY 18, 2023

By definition, Revenue Cycle Management (RCM) is the process by which healthcare providers manage and track the revenue generated by patient care. Fraud detection: AI can be used to detect and prevent fraudulent activity in the revenue cycle, such as billing for services that were not provided or upcoding of services.

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Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. The FCA is a fraud statute, requiring intent. Potential Impact. The public has until 5 p.m.

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Overpayments Overpayment ACA Medicare 52

Provider Trust

MAY 17, 2022

In this post, we’ll break down the definition of healthcare vendors and summarize the most important and impactful laws and regulations that apply to vendors and the healthcare organizations that contract with them. So what does that mean for your healthcare organization’s compliance program? How to ensure vendor compliance.

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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. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

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Hall Render

MAY 9, 2022

In connection with the COVID-19 public health emergency (the “PHE”), and the expanded coverage of telehealth services by Medicare and state Medicaid programs in response thereto, the FQHC received grant funding from the Federal Communications Commission and a local charity to purchase approximately 3,000 smartphones.

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AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This includes understanding various fraud and abuse laws. This is also called “store-and-forward telemedicine.”

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Hall Render

JULY 12, 2023

If a deemed hospice fails to meet the Medicare requirements or shows continued condition-level noncompliance, deemed status is generally removed and oversight is placed under the SA. Selected hospices either successfully complete the SFP program or are terminated from the Medicare program. of hospice providers reported data.

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AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. Does your organization have materials for patient education and risks of identity theft and medical fraud?

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Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

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.

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Provider Trust

MAY 18, 2022

As referenced in our recent post on definitions and regulations for healthcare vendors, the HHS Office of Inspector General Exclusions Program mandates that healthcare organizations refrain from doing business with “excluded or sanctioned” individuals or entities, which includes your organization’s network of vendors.

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Compliance Due Diligence Medicaid Medicaid 52

AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. Does your organization have materials for patient education and risks of identity theft and medical fraud?

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Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 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.

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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 Elizabeth Medical Center to receive nearly $400k in federal funds to combat substance abuse UofL lands nearly $12 million grant from National Institute of Health Winchester physician Michael Kuduk, M.D.,

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Healthcare Law Blog

NOVEMBER 16, 2023

Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”). [1]

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Health Law RX

JULY 18, 2023

The IB Rule, among other things, promulgated regulations further defining what information blocking is and establishing reasonable and necessary activities that do not constitute information blocking, i.e., exceptions to the definition of information blocking. The OIG anticipates working closely with ONC to make these threshold assessments.

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Hall Render

APRIL 6, 2022

The relator alleged that these programs and subsequent reporting of the retail price, and not the discounted price, violated Medicare Part D’s requirement that a pharmacy must report the usual and customary price charged for the drugs. This footnote originated as a footnote in a memorandum issued by CMS in October of 2006.

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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. Even developing this data may not be sufficient. Deactivation.

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Health Law Advisor

MARCH 7, 2023

The proposed rules also clarify that a telemedicine encounter that results in a controlled substance prescription requires the health care professional treating the patient to use an interactive telecommunications system, and directly refers to the Medicare definition of that term at 42 C.F.R. Impact on Pharmacies. 4] 21 C.F.R.

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Verisys

FEBRUARY 1, 2022

All individuals and organizations that meet the definition of healthcare provider as described in 45 CFR 160.103 that conduct transactions or use health records that fall under HIPAA regulations are required to obtain an NPI. Providers also need an NPI prior to enrolling in Medicare. Who Needs an NPI? . When Did NPI Numbers Begin?

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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.

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C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Actuarial Soundness. Information Accessibility Requirements.

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Hall Render

AUGUST 4, 2023

1 CMS final rule boosts Medicare hospice payments by 3.1% 1 CMS final rule boosts Medicare hospice payments by 3.1% to settle Medicare fraud claims Maine in top 10 for health care, No. To Address SDOH Needs U.S. To Address SDOH Needs U.S. Louis-area nurses shows staffing shortages, burnout, abuse by patients St.

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AIHC

FEBRUARY 16, 2024

To begin, the authors use Medicare patients who are diagnosed with aspiration pneumonia: “This study, one of the largest undertaken of aspiration pneumonia, confirms that patients with aspiration pneumonia are older, have more comorbidities, and are more likely to die than with other forms of pneumonia.

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AIHC

FEBRUARY 16, 2024

To begin, the authors use Medicare patients who are diagnosed with aspiration pneumonia: “This study, one of the largest undertaken of aspiration pneumonia, confirms that patients with aspiration pneumonia are older, have more comorbidities, and are more likely to die than with other forms of pneumonia.

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Hall Render

OCTOBER 27, 2023

Million Health Care Fraud Conspiracy in Idaho Orthopedic activity in the 5 most underserved states St. Ransomware attacks against hospitals put patients’ lives at risk, researchers say States, FTC continue to target noncompetes: 3 updates The best hospital in each state, per Newsweek What to know about Stark law’s $9.2M

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Hall Render

AUGUST 12, 2022

Doctor loses at least four homes, sentenced to federal prison for healthcare fraud amounting to $38M. million in restitution in complex telemedicine fraud scheme. 5 Things Hawaii: COVID testing profits, Nursing workforce, Medicare physician fees. million over allegations it defrauded Medicare. HHS Awards Over $3.1

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New Jersey Healthcare Blog

JULY 22, 2022

The Department denied petitioner’s request to define the term “next of kin” and add it to the definition section at N.J.A.C. The Board is also changing subsection (a) to include a definition for the term “opioid antidote.” The petitioner requested the Department amend N.J.A.C. On June 20, 2022, at 54 N.J.R.

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Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. health care spending hits $4.5 approval for obstetrics services in Prince George’s County Maryland health system gets state OK for $300M labor, delivery unit Maryland hospitals must pay back millions to poor patients.

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Hall Render

JANUARY 19, 2024

Bipartisan Ky. hospital company Kansas City Orthopaedic Institute appoints new CEO Kansas City University’s new research center aims to answer: ‘How do we keep people well?’ in costs, report finds Pennsylvania hospital staff vote for union removal St.

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Hall Render

NOVEMBER 17, 2023

million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million patients stolen during ransomware attack MINNESOTA CFO of the Year 2023: Penny Cermak, HealthPartners Inc.

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