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Insurers may be padding Medicaid physician networks, study finds

Healthcare Dive

Some doctors listed in managed care provider network directories didn't file any Medicaid claims over the course of a year, according to new research published in Health Affairs.

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Medicare and Medicaid Allows Doctors to Practice Across State Lines

Healthcare IT Today

One of the biggest health IT related news items to come out was the announcement by Vice President Mike Pence that HHS was issuing a regulation to permit doctors to practice across state lines. State Medical Licensure is something that has baffled many of us that have worked in healthcare.

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Why Accurate Data is a Lifeline to Care in the Medicaid Redetermination Cycle

HIT Consultant

Adimika Arthur, Executive Director, HealthTech 4 Medicaid Manisha Sharma, Senior Medical Director, Promise Health Plan Blue Shield of California During the pandemic, Medicaid enrollment grew by nearly 30% to cover more than 93 million Americans , due in large part to COVID-19 provisions that included continuous Medicaid enrollment.

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Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Med-Net Compliance

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Medicare and Medicaid data demonstrated that he was identified as an outlier and the highest biller for this procedure in New York State.

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Understanding the Process of Credentialing Doctors

Medisys Compliance

What is Credentialing Doctors? Credentialing of doctors is a process that involves the evaluation of a doctor’s qualifications, education, training, licensure, and experience to determine if they meet the requirements set by the insurance company.

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Medical Debt in the U.S. Greater in States That Did Not Expand Medicaid

Health Populi

Furthermore, the flow of medical debt was greater among health citizens living in states that did not expand Medicaid as part of the Affordable Care Act, compared with patients who reside in Medicaid expansion states, according to an original research essay, Medical Debt in the US, 2009-2020 published in JAMA on 20 July 2021.

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Missouri Woman Sentenced for Medicare and Medicaid Fraud

Healthcare Compliance Blog

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. General Legal Duties and Antitrust Laws.

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