AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. 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.

Fraud 52

Fraud Compliance Medicare Medicare 52

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud.

Overpayments 93

Overpayments Overpayment COVID-19 Medicare 93

C&M Health Law

DECEMBER 18, 2023

OIG also specifically calls out the growing presence of private equity and other forms of private investment in health care and recommends that such investors scrutinize their operations and oversight to ensure compliance with fraud and abuse laws and the delivery of high-quality care for patients.

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

Hall Render

JANUARY 19, 2024

Francis emergency room KENTUCKY Apollo’s 220-hospital ‘stranglehold’ harms patients and workers, report alleges Humana cuts ‘small’ number of jobs in multiple locations LMU School of Nursing will open Lexington site at CHI Saint Joseph Health Mercy Health announces acquisition of orthopedic center in Paducah, Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M in 256-Slice CT scanner Lifepoint reports $200M+ economic impact in Cen Ky St.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away. In March 1996, Rep.

HIPAA 119

HIPAA Fraud Health Insurance Health Care Reform 119

Hall Render

MARCH 22, 2024

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

Kaiser Health News

OCTOBER 13, 2022

For the first time, Medicare Advantage plans are poised to enroll more than half of the Medicare population despite allegations that many of the largest insurers are getting billions of dollars in overpayments from the federal government.

Medicare 67

Medicare Medicare ACA Governance 67