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HHS watchdog reiterates importance of preventing telemedicine fraud

Healthcare IT News - Telehealth

Department of Health and Human Services' Office of Inspector General recognized telehealth's potential while cautioning that steps must be taken to ensure virtual care will not be compromised by fraud. Grimm in her statement also differentiated between telehealth fraud and "telefraud" schemes. THE LARGER TREND.

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CMS Program Integrity’s Role in Combatting FWA While Maintaining Health Equity

HIT Consultant

Tom Wriggins, Principal Industry Advisor at SAS John Maynard, CPA, CFE, AHFI Principal Solutions Architect at SAS In 2022, the Center for Medicare and Medicaid Services (CMS) established health equity as a pillar of its future work. Health outcomes and Medicaid program integrity Health outcomes are a function of the quality of care.

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Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare

Innovaare Compliance

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

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CMS Announces Proposed Rule: Transforming Episode Accountability Model “TEAM”

Hall Render

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

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CMS Issues Contract Year 2023 Final Rule for Medicare Advantage Organizations and Prescription Drug Sponsors

Healthcare Law Blog

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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Why Data Analytics are Critical in a Value-Based Care (VBC) Environment

AIHC

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. percent of the gross domestic product (GDP) on healthcare, which was almost two times the average of other high-income countries, while the health outcomes in the U.S. healthcare system were exorbitant.

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OIG Advisory Opinion Alert: Yet Another Favorable Decision for Medical Device Manufacturers

Healthcare Law Blog

On Thursday, March 16, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) issued OIG Advisory Opinion (“AO”) No. 22-05 , relating to subsidization of certain Medicare cost-sharing obligations in the context of a clinical trial involving medical devices (the “Proposed Arrangement”).