HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 81

Medicaid Medicaid Ransomware Health Insurance 81

MRO Compliance

JUNE 1, 2022

Information You Need to Know about a HEDIS Audit from Revenue Cycle Experts. Below we explore some common questions about HEDIS and review important information your team should know now and in the future. Below we explore some common questions about HEDIS and review important information your team should know now and in the future.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

Hall Render

AUGUST 22, 2023

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. the government alleged a clinical pharmacy manager for a Tennessee Walgreens falsified twelve different patients’ medical records between January 2015 and June 2016.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

HIPAA Journal

NOVEMBER 17, 2022

Caroline Cook, Privacy Consultant, GDH Government Consulting Services, has shared her thoughts. I then left acute care and began a career as a Privacy Consultant, obtaining three different certifications as an information privacy professional. I’m a Privacy Consultant employed by GDH Government Consulting Services.

Governance 86

Governance HIPAA Compliance Nursing Homes 86

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

Healthcare Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-417836, 2020 CPD ¶ 47 ( Nov. 2021 CPD ¶ 325 (Nov.

Governance 52

Governance Department of Veterans Affairs Medicaid Medicaid 52

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. The Consolidated Appropriations Act of 2023 requires Medicaid plans to publish and update accurate and searchable provider directories.

Governance 144

Governance Medicaid Medicaid Medicare 144

Hall Render

DECEMBER 20, 2023

For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency. Public Posting of Data CMS finalized the Proposed Rule’s requirement that the information provided per Section 1124(c) of the Act be publicly available within one year of the Final Rule.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds. 29, 2018.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Bill of Health

JANUARY 23, 2024

Medicaid pays for more than 40% of births in the U.S., Examining efforts at the federal and state level, I highlight three options, leveraging Medicaid as a policy lever. In the past, when individuals were Medicaid-eligible due to pregnancy, federal law required states to provide coverage for at least 60 days postpartum.

Medicaid 111

Medicaid Medicaid Patient Satisfaction Health Insurance 111

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

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.

ACA 138

ACA Health Insurance Governance Medical Billing 138

Healthcare It News

OCTOBER 31, 2022

The pilot, funded under a cooperative agreement by the Office of the National Coordinator for Health IT (ONC) and Health Level Seven International (HL7), focuses on applying FHIR Gravity social risk terminology – to exchange information. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org.

Licensing 254

Licensing Health Outcomes Medicaid Medicaid 254

Verisys

FEBRUARY 8, 2024

The bill requires the board to post an online statement directing the public to contact the board for more information concerning a formal name change. Federal regulations require Medicaid to enroll an Ordering, Referring, and Prescribing (ORP) practitioner as a participating provider for services billable to the Medicaid program.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Nurses 52

Healthcare IT News - Telehealth

JANUARY 23, 2023

We spoke with the HIMSS government relations team for their thoughts on those priorities and more in 2023 and beyond. HIMSS will "use the next two years to gather additional data to inform both Congress and CBO on either the cost of avoidance or the cost control aspects," said Leary.

Medicare 143

Medicare Medicare Governance Medicaid 143

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 59

Ransomware Governance Compliance HIPAA 59

HIT Consultant

JUNE 26, 2023

signed a Letter of Intent with CRISP Shared Services to participate in a health data interoperability pilot program that will lay the foundation for OHIT’s Health Information Exchange in the Territory. Virgin Islands (USVI) Governor Albert Bryan Jr. Why It Matters OHIT Director Michelle M.

US Department of Health and Human Services 52

US Department of Health and Human Services Local Policy Governance Medicaid 52

Health Law Advisor

AUGUST 30, 2023

In a decision that significantly levels the field for providers, the District Court ruled in part for the provider plaintiffs and in part for the Government in the TMA III ruling. The Centers for Medicare & Medicaid Services (“CMS”) responded to the ruling by temporarily suspending all Federal (i.e., Earlier this month, the U.S.

Governance 105

Governance Medicaid Medicaid Medicare 105

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 52

Ransomware Governance Compliance HIPAA 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

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 98

Fraud Medicaid Medicaid Doctors 98

Verisys

DECEMBER 5, 2023

Because they have first-hand knowledge, these primary sources can confirm if the information claimed is accurate. An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs.

Governance 52

Governance Licensing Malpractice Medicaid 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. Several weeks.

Licensing 52

Licensing Governance Compliance Fraud 52

Hall Render

FEBRUARY 10, 2023

North Carolina legislators are considering a Medicaid expansion bill that includes a repeal of its CON law. Higher interest rates have resulted in fewer government and non-profit health care providers going to market to place debt. Hall Render blog posts and articles are intended for informational purposes only.

Medicaid 40

Medicaid Medicaid Hospitals Governance 40

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. Educating patients on how to reduce their overall risk helps protect their health information.

Fraud 52

Fraud Medicare Medicare Compliance 52

HIT Consultant

JULY 17, 2023

Cessation of PHE telehealth, prescribing, and mental health access exceptions could impact the Medicaid population the most. Twenty-one percent of Medicaid enrollees have mild, moderate, or severe SUD, compared to 16% of commercially insured individuals. And as of the latest data, 7.3% And as of the latest data, 7.3%

Public Health 95

Public Health Medicaid Medicaid Electronic Medical Records 95

Hall Render

JUNE 20, 2022

Is housing health care and should Medicaid pay the rent? States are using Medicaid programs to cover rent, security deposits and furniture per The New York Times. State and local governments are stepping up to save facilities on the brink of closure. Senior housing facilities continue to struggle financially.

Medicaid 40

Medicaid Medicaid Hospitals Nurses 40

HIT Consultant

MARCH 8, 2022

Under the PHE, states must keep Medicaid enrollees continuously covered, irrespective of their circumstances. . 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.

Public Health 97

Public Health Medicaid Medicaid Health Insurance 97

Total Medical ComplianceHIPAA

NOVEMBER 13, 2023

HIPAA: Who can be fined under the Information Blocking Rule and what are the Office of Inspector General’s (OIG) priorities? Only certain entities are currently subject to an OIG information blocking penalty. More information can be found on the website for your local medical and dental boards, OSHA, and other regulatory agencies.

HIPAA 52

HIPAA Medicaid Medicaid Medicare 52

Health Care Law Brief

JUNE 5, 2023

In 2013, Jelly Bean contracted with the Florida Health Kids Corporation (“ FHKC ”)—a state-created entity that offers health and dental insurance for Florida children—to create, host, and maintain HealthyKids.org, where, in part, parents and others could apply for state Medicaid insurance coverage for eligible children.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

Healthcare It News

OCTOBER 25, 2022

"We have expanded access to care and kept people safe with telehealth services," said Tom Leary, senior vice president and head of government relations at HIMSS. has the highest maternal mortality rate when compared with other countries with similar wealth.

COVID-19 212

COVID-19 Medicaid Medicaid Public Health 212

HIT Consultant

MARCH 9, 2023

Rajesh Sharma, Vice President and General Manager of Systems Integration, Data Analytics and Interoperability Product Offerings, Gainwell Technologies The Centers for Medicare and Medicaid Services (CMS) has laid the critical groundwork to create a connected healthcare system in which patients, providers, and payers can easily exchange information.

Health Outcomes 81

Health Outcomes Governance Compliance Medicaid 81

MedTrainer

OCTOBER 4, 2023

Federal healthcare compliance requirements encompass a set of regulations and laws established by various government agencies to ensure certain standards for the healthcare industry at the national level. CMS plays a crucial role in overseeing federal healthcare programs, including Medicare and Medicaid. Office for Civil Rights (OCR).

Compliance 52

Compliance Fraud HIPAA Governance 52

HIT Consultant

MAY 2, 2023

For decades, the industry lacked a patient-centric approach focused on efficiency, reliability, and accessibility for all populations, especially those enrolled in Medicare Advantage and Medicaid plans. In a recent study , 21% of U.S. adults without access to a vehicle or public transportation skipped needed medical care last year.

Medicaid 85

Medicaid Medicaid Medicare Medicare 85

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 With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52