Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

MAY 2, 2023

Modern NEMT solutions streamline the ride booking and scheduling process, introduce new modalities, improve the overall experience for patients, and decrease fraud, waste and abuse (FWA). As Medicare Advantage and Medicaid plans continue to grow, NEMT partners will play an increasingly important role in scaling transportation benefits.

Medicaid 96

Medicaid Medicaid Medicare Medicare 96

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

HIPAA Journal

OCTOBER 10, 2022

According to the breach notice, a presentation was emailed to the DHS Children’s Long-Term Support Council in April 2021 that contained protected health information. Steps were also taken to recover all distributed copies of the presentation.

Medicaid 56

Medicaid Medicaid Governance Fraud 56

Bill of Health

FEBRUARY 10, 2023

This replacement, “neoliberalism,” has as its central tenet that markets are, in all ways and at all times, superior to government in allocating societal resources. That is why the ACA’s Medicaid expansion doesn’t exist in 11 states , why the penalties for failing to have insurance under the “individual mandate” has been set to $0.00.

Public Health 261

Public Health Health Care Reform ACA COVID-19 261

Healthcare IT News - Telehealth

JANUARY 26, 2022

Healthcare IT News interviewed Griffin to take a closer look at what he will be presenting at the HIMSS22 conference. The evergreen concern about virtual care is that of fraud, waste and abuse and how to balance it with the demonstrated value of extended medical services to patients who are either geographically or economically underserved.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. Excluded individuals and entities are listed in the OIG’s exclusions database.

Fraud 59

Fraud Compliance Medicare Medicare 59

McGuire Wood

OCTOBER 2, 2023

times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure.

Fraud 52

Fraud Governance Compliance Medicare 52

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

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

AIHC

NOVEMBER 29, 2023

As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Provider Trust

JULY 8, 2022

In this quick guide, we’ll explore the importance of including NPDB monitoring in your routine license and exclusion monitoring to protect your organization and the patients you serve from fraud, waste, and abuse. Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S.

Licensing 52

Licensing Malpractice Fraud Compliance 52

AIHC

NOVEMBER 29, 2023

As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

JUNE 2, 2022

Therefore, a telehealth platform operating in all 50 states will, for example, need to comport with the laws governing corporate formation, provider licensure, scope of practice, and telehealth encounters in all 50 states. Variety of Risks Present in Telehealth Arrangements. Provider Licenses. How is this disclosed to consumers?

Public Health 52

Public Health Compliance COVID-19 Licensing 52

Med Law Blog

MAY 1, 2023

As you might expect from a federal investigation, conducted by politicians with media present, the tone of the meeting was more hostile rather than supportive. In March 2023, the House Ways and Means Committee hosted an investigative hearing on “private equity’s expanded role in the US healthcare system”.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 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. The Arrangement contains safeguards that lower the risk of fraud and abuse under the federal AKS.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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 includes understanding various fraud and abuse laws.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare Law Blog

MAY 31, 2022

These advancements, present challenges and raise novel questions as to how the current healthcare and life sciences legal regime would apply to the metaverse. The healthcare system in the United States is governed by an expansive network of state and federal laws, including the aforementioned HIPAA regulations. Healthcare Laws.

FDA 90

FDA HIPAA Medicare Medicare 90

Hall Render

JUNE 7, 2023

This practice implicated the pharmacies’ contracts with Pharmacy Benefit Managers (“PBMs”) as well as Medicaid and other federal health care programs. At the patient’s request, the pharmacies would match the lowest drug price and apply that discounted price to future refills for these patients.

Fraud 40

Fraud Medicaid Medicaid Governance 40

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

JULY 28, 2023

million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.

US Department of Health and Human Services 40

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

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. Standard Contract Requirements/Coordination of Benefits.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

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

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

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

Hall Render

MAY 13, 2022

Prism pays $650K to settle Medi-Cal fraud claims filed in San Diego. ‘So much is new’: ScionHealth launch presents wealth of opportunities, CFO says. Troubled NC nursing home set to lose nearly all its government funding — and patients. Government watchdog: Health care giants improperly denied Medicare benefits.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Health Law RX

JULY 18, 2023

The CMP Final Rule also addresses enforcement and CMPs for fraud, false claims, or similar conduct in HHS grants, contracts, and other agreements, which are not addressed in this article. Health IT vendors should consider information blocking to be a new frontier of fraud and abuse enforcement. See 42 U.S.C. 1320a–7a(d).

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Med-Net Compliance

NOVEMBER 1, 2022

South Carolina Attorney General Alan Wilson announced that his office’s Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old woman for allegedly practicing medicine as a registered nurse without a license at seven nursing and assisted living facilities in Anderson, Greenville, and Pickens counties.

Nursing Homes 59

Nursing Homes Licensing Nurses Fraud 59

Hall Render

APRIL 6, 2022

Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” Guidance Must Be Truly Authoritative and Must Come from An Actual Authority.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Hall Render

MARCH 3, 2023

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

AUGUST 19, 2022

Stockton Doctor and Medical Practice Agree to Pay Nearly $2 Million to Resolve Allegations of Health Care Fraud. PruittHealth CEO: Nursing Home Operators Can’t Break Into Small Markets Without Government Support. ‘The unwinding’: Idaho Medicaid must recheck eligibility for 131K people when U.S. emergency ends.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40

Hall Render

FEBRUARY 25, 2022

AI in Healthcare Presents Need for Security, Privacy Standards. CMS overhauls Direct Contracting model to include new requirements on governance, health equity in 2023. Why some Medicaid providers in Colorado aren’t getting paid. Missouri Takes Months to Process Medicaid Applications — Longer Than Law Allows.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

OCTOBER 6, 2023

government grant for maternal health care Alabama slides to 50th on nursing home and long-term care report card Ascension sells Alabama hospital Ascension St.

US Department of Health and Human Services 40

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

Hall Render

OCTOBER 6, 2023

government grant for maternal health care Alabama slides to 50th on nursing home and long-term care report card Ascension sells Alabama hospital Ascension St.

US Department of Health and Human Services 40

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

Hall Render

MARCH 25, 2022

Alabama lawmaker’s push to extend postpartum Medicaid coverage. $12 Florida Medicaid hits Sunshine Health with $9M sanction for not paying providers’ claims. increase for 2023 Medicaid budget. 2 sentenced for $48M medical reimbursement account fraud scheme. lawmaker presents plan to improve women’s healthcare.

COVID-19 40

COVID-19 US Department of Health and Human Services Nursing Homes Nurses 40

Hall Render

FEBRUARY 2, 2024

continues crackdown on nursing homes, 2 more cited for poor care and ‘massive fraud’ Wow! Mary’s welcome new board members Northeast Georgia Health System named one of nation’s top workplaces for diversity HAWAII How Adventist Health Castle achieved becoming a verified Level III Trauma Center Queen’s debuts $4.5M

Nursing Homes 40

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