The Health Law Firm Blog

NOVEMBER 18, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D.,

Medicare 40

Medicare Medicare Hospitals Governance 40

Health Populi

JUNE 5, 2022

Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for health insurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large health insurance companies.

Overpayments 149

Overpayments Overpayment Medicare Medicare 149

The Health Law Firm Blog

AUGUST 23, 2022

Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Hospitals Governance 52

Kaiser Health News

APRIL 16, 2024

District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards. Some consumers were switched multiple times or had duplicative policies.

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ACA Health Insurance Governance Medical Billing 138

Bill of Health

DECEMBER 6, 2023

By Hannah Rahim Many mental health provider directories for private and public insurance plans contain inaccurate or outdated provider information , which creates a misleading illusion of accessible care. These ghost networks result in many patients being unable to access essential mental health care.

Governance 144

Governance Medicaid Medicaid Medicare 144

Health Populi

JUNE 18, 2021

with employer-sponsored health insurance worry that a major health event in their household could lead to bankruptcy, according to research gathered by West Health and Gallup in Business Speaks: The Future of Employer-Sponsored Insurance. Health Populi’s Hot Points: U.S. One-half of U.S.

ACA 133

ACA Health Insurance Medicaid Medicaid 133

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This wastes taxpayer money and interferes with your medical care. trillion in 2015.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare IT News - Telehealth

FEBRUARY 3, 2023

WHY IT MATTERS The bill aims to keep stand-alone telehealth benefits separate, not as a replacement of medical plans, offering them under a group health plan or group health insurance coverage as excepted benefits. In addition to improving access, telehealth reduces burdens on healthcare providers.

Public Health 161

Public Health COVID-19 Medicare Medicare 161

Kaiser Health News

NOVEMBER 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. “You’re not from Medicare,” Heimer told her.

Medicare 144

Medicare Medicare Doctors Fraud 144

Medisys Compliance

FEBRUARY 27, 2024

Understanding Regulatory Framework Radiology billing is governed by a multitude of regulations at the federal, state, and local levels. Audit Processes Radiology practices are subject to audits by various entities, including Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and private payers.

Compliance 59

Compliance Medical Billing Outsourcing Medicare Medicare 59

HIT Consultant

AUGUST 8, 2022

Wall Street has largely focused on CVS’s efforts to add primary-care practices and doctors to its payroll, though executives have also discussed their ambitions to expand its in-home health presence. Signify uses analytics and technology to help health plans, employers, physician groups and health systems with in-home care.

Governance 97

Governance Medicare Medicare Health Insurance 97

Healthcare IT News - Telehealth

JULY 16, 2021

The Australian government has made available two new subsidised telephone consult services for patients living in COVID-19 hotspot areas. In a statement on Thursday, Health Minister Greg Hunt said the new Medicare items will enable doctors to provide 20 minutes or more of telephone consultations. WHY IT MATTERS. ON THE RECORD.

COVID-19 82

COVID-19 Governance Doctors Medicare 82

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. What is Healthcare Compliance?

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

Verisys

JANUARY 8, 2024

This includes adherence to standards set by the Health Insurance Portability and Accountability Act (HIPAA) , the Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies. Involves ensuring adherence to laws and regulations specific to the healthcare industry.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

Health Populi

DECEMBER 9, 2021

being covered by health insurance is one of the social determinants of health. Without a health plan, an uninsured person in America is far more likely to file for bankruptcy due to medical costs, and lack access to needed health care (and especially primary care). In the U.S.,

Medical Billing 73

Medical Billing Health Insurance Medicaid Medicaid 73

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 Managed care now covers more than half of Medicare enrollees and over 80% of Medicaid enrollees.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

NOVEMBER 14, 2023

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Exclusion from Government Programs: Entities found non-compliant may be barred from participating in government healthcare programs like Medicare and Medicaid. What Is Healthcare Compliance?

Compliance 52

Compliance HIPAA Governance Medicare 52

MedTrainer

APRIL 11, 2024

They are responsible for developing policies that govern the employment relationship between the organization and its employees. They develop and implement compliance programs that include policies, practices, and procedures to ensure all departmental operations align with federal and state laws.

Compliance Officers 52

Compliance Officers Compliance Medicaid Medicaid 52

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

HIPAA 88

HIPAA Fraud Health Insurance Medicaid 88

Innovaare Compliance

MARCH 24, 2024

According to the National Health Care Anti-Fraud Association, the financial losses due to healthcare fraud are estimated to be in the billions of dollars annually. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

Healthcare IT News - Telehealth

MAY 26, 2021

World governments have also delivered telehealth services, free of charge, for their citizens. In Australia , over 56 million telehealth services paid for by Medicare, the country's universal health insurance system, were brought to about 13.6 million patients over the past year.

Telemedicine 152

Telemedicine COVID-19 Doctors Licensing 152

Healthcare IT Today

MAY 15, 2023

The Company takes a local approach – with local brands and local teams – to provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals.

Medicare 80

Medicare Medicare Governance Health Insurance 80

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

HIPAA Journal

JUNE 8, 2023

Names, addresses, Social Security numbers, and health insurance were impermissibly disclosed. MCNA Dental has offered affected individuals complimentary credit monitoring services. Explanation of payment notices containing the information of 833 Iowa Medicaid recipients were sent to 20 providers in error.

Medicaid 80

Medicaid Medicaid Ransomware Health Insurance 80

MedTrainer

APRIL 8, 2024

As a healthcare professional, it is vital to maintain compliance with the 629 legal and regulatory requirements that govern the delivery of quality care. Legal And Regulatory Requirements In Healthcare More than 620 legal and regulatory requirements govern how the healthcare industry ensures patient safety, privacy, and quality of care.

Compliance 52

Compliance Governance ACA HIPAA 52

American Medical Compliance

MARCH 15, 2024

Furthermore, it prohibits knowingly submitting false or false claims to Medicare, Medicaid, or other federally funded healthcare programs. HIPAA regulations govern the use, disclosure, and safeguarding of protected health information (PHI) by covered entities and their business associates.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

Healthcare It News

FEBRUARY 28, 2023

The payer mix of health insurance is typical, with 35% of patients representing government insurance such as Medicare or Medicaid, 60% commercial insurance, and 6% self-pay patients. The majority of patients using the virtual-first clinic are females (70%), and the average age range has been 40-50.

Electronic Medical Records 235

Electronic Medical Records Telemedicine Health Insurance Health Outcomes 235

MedTrainer

JUNE 28, 2023

The primary goal of a Certified Fraud Examiner in healthcare is to safeguard the integrity of healthcare systems and protect patients, insurance providers, and government programs from financial losses due to fraudulent activities. Health Insurance Portability and Accountability Act (HIPAA). Anti-Kickback Statute (AKS).

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Health Populi

APRIL 16, 2024

Presidential elections to that point, and that the last retiring Baby Boomer enrolls in Medicare that year. Let’s take a walk with “Quincy” through each of the four worlds to see how their health care experience might play out across the key driving forces. Fewer employers feel compelled to provide health insurance in this environment.

Public Health 73

Public Health Governance Medicare Medicare 73

HIT Consultant

MARCH 8, 2022

By December 2021, enrollment in Medicaid and CHIP (Children’s Health Insurance Program) grew to a record high of more than 83 million individuals, primarily due to the continuous coverage requirements of the PHE. In the long run, this causes economic hardship to the state, healthcare providers, and insurers.

Public Health 98

Public Health Medicaid Medicaid Health Insurance 98

MedTrainer

JANUARY 12, 2024

Healthcare facilities, from hospitals and clinics to insurance providers, are deeply affected by the regulations set forth by the Health Insurance Portability and Accountability Act (HIPAA). Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

HIPAA 52

HIPAA Compliance Health Insurance Hospitals 52

MedTrainer

JANUARY 31, 2024

federal government enacted the Federal False Claims Act (FCA) in 1863 during the American Civil War. It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. Healthcare compliance isn’t a new concept. Who started the first healthcare compliance program?

Compliance 52

Compliance Fraud Governance ACA 52

HIT Consultant

APRIL 24, 2023

Continuing staff shortages, endemic COVID-19, high inflation rates, and supply chain disruptions continue to drive medical costs higher, worsening what is already a persistent challenge for health insurers. This process takes place in Medicare, where the payor is the administrator of plans that are paid by the U.S. of the U.S.

Health Insurance 52

Health Insurance COVID-19 Medicare Medicare 52

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. The new broker provision aims to deter fraudulent sign-ups by clarifying that applicants must attest that the income projections listed are correct.

ACA 72

ACA Health Insurance Licensing Governance 72

Medisys Compliance

JULY 11, 2022

The Centers for Medicare & Medicaid Services (CMS) has released Frequently Asked Questions (FAQs) on the No Surprises Act implementation, providing details about balance billing and notice and consent prohibitions. These requirements are collectively referred to as “No Surprises” rules. Patient Protection against Balance Billing.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Health Insurance Medicaid 52

Healthcare IT News - Telehealth

DECEMBER 17, 2021

"The defendants caused losses to TRICARE, Medicare, and private health insurance companies of approximately $37 million," wrote DOJ officials in a press release. WHY IT MATTERS. The agency said that patient information had been provided by marketing companies. THE LARGER TREND.

Fraud 127

Fraud Telemedicine Nurses Licensing 127