Health Care Law Brief

APRIL 12, 2023

. § 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Determinations of medical necessity will need to follow national coverage determinations, local coverage determinations, or, where none are applicable, plans must follow publicly available, evidence-based coverage criteria. See 42 U.S.C.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. It can result in a situation where insurance opens an investigation or decides to initiate periodic audits on your claims and records. They can, sometimes!

Fraud 52

Fraud Compliance Medicare Medicare 52

Hall Render

OCTOBER 7, 2022

After court ruling for AHA in 340B case, HHS says it will start adjusting payment rates for certain 340B hospitals within approximately two weeks. Congress gives rural hospitals a reprieve, for now. Hospital leaders meet at White House to talk ‘twindemic’ strategies. Is the doctor’s office heading for extinction?

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40