AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Now, let’s talk more about qui tam action.

Fraud 52

Fraud Compliance Officers 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. It can result in a situation where insurance opens an investigation or decides to initiate periodic audits on your claims and records.

Fraud 52

Fraud Medicare Medicare Compliance 52

AIHC

NOVEMBER 29, 2023

The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. 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

Kaiser Health News

MAY 31, 2022

Cigna’s negotiated rate was $4,144, and Melville’s share under her insurance was $2,185. And often the doctors and hospitals are the ones who decide when those categories shift and a patient can be charged — but those decisions often are debatable.

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ACA Doctors Medical Billing Hospitals 103

Healthcare Law Blog

MAY 16, 2022

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”). Enrollee Participation in Dual Eligible Special Needs Plan (“D-SNP”) Governance (§ 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

NY Health Law

APRIL 15, 2021

While the laws governing telehealth were becoming gradually more permissive, progress was slow. Pending legislation addresses the amount of reimbursement available for telehealth (both by Medicaid and commercial insurers) and permissible modalities (including asynchronous telemedicine).

Informed Consent 52

Informed Consent Malpractice Telemedicine Medicaid 52

Health Populi

MAY 6, 2018

government (which offers several flavors of plans through the VA, Tricare for active military, Medicare for aging people and Medicaid for people with low-incomes) or private sector employers, unions, and other insurance-conveners. Affordability remains elusive in U.S. healthcare.

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Medicaid Medicaid Medicare Medicare 54

HIPAA Journal

MARCH 31, 2023

These generally fall into two categories – HIPAA medical records retention and HIPAA records retention requirements. The distinction between the two categories is that there are no HIPAA medical records retention requirements, but requirements exist for other documentation.

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HIPAA Medicare Medicare Compliance 129

Health Populi

JUNE 20, 2019

Note that the findings on how people know they are eating well fall into four categories: health, enjoyment, mindfulness, and their budget. Intriguingly, government agencies tie at one in five people for both being on my side and working against me. Health benefits are sought by 6 in 10 people.

Doctors 71

Doctors Governance FDA Medicaid 71

Bill of Health

SEPTEMBER 9, 2022

Consider, for example, the Coronavirus State and Local Fiscal Recovery Funds Program (SLFRF) — enacted as part of the American Rescue Plan Act — which provided $350 billion in flexible aid to state, local, tribal, and territorial governments. This precludes rebuilding the decimated public health workforce.

Public Health 362

Public Health COVID-19 Public Health Professionals Governance 362

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. Risk-Sharing Mechanisms.

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Medicaid Medicaid Medicare Medicare 40

Kaiser Health News

JULY 6, 2022

“There are still some gaps that need to be filled,” said Katie Keith, a researcher at the Center on Health Insurance Reforms at Georgetown University. And, if you get a bill from a physician, clinic, or hospital that you think might qualify for no cost sharing, call your insurer to inquire or dispute the charge.

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ACA Medicare Medicare Medicaid 76

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. There are two categories of denials: 1. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

Healthcare Law Blog

JANUARY 11, 2023

It’s also enough to cause the chief executive officers of these three plans to discuss the possibility of industry litigation against the federal government – which threat was effective in an earlier round of health plans versus CMS and delayed audits, enforcement actions and repayments under the Medicare Advantage risk adjustment program for years.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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. Orthopedic surgeon allegedly exaggerated patient visits to defraud insurers. State overcounts vaccinations by 600,000 people.

COVID-19 40

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

Jane Sarashon

DECEMBER 13, 2021

This big number is comprised by personal care and beauty (which had various shifts within the category in the pandemic – less color cosmetics and more skin health and hygiene), health eating and nutrition and weight loss, physical activity, and wellness tourism, among other categories.

COVID-19 62

COVID-19 Public Health Governance Medicaid 62

Kaiser Health News

JUNE 6, 2022

For the second time in three years, Espinosa faces the prospect of losing permission to work, which would cost him not only his job providing tech support at a software company, but also his health insurance. Without health insurance, his daughter would lose her eligibility for transplants.

Health Insurance 73

Health Insurance Doctors Governance Licensing 73

HIPAA Journal

JANUARY 2, 2023

This violation category includes disclosing PHI to a patient’s employer, potential disclosures following the theft or loss of unencrypted laptop computers, careless handling of PHI, disclosing PHI unnecessarily , not adhering to the ‘minimum necessary’ standard, and disclosures of PHI after patient authorizations have expired.

HIPAA 109

HIPAA Compliance Hospitals Medicare 109

Kaiser Health News

NOVEMBER 22, 2022

Thousands of nurses at Stanford Health Care were told in April they would lose their health insurance if they did not return to work during their weeklong strike. Freezing health insurance benefits is a common tactic in a labor dispute because without them, workers might be more easily persuaded to concede to management’s demands.

Health Insurance 58

Health Insurance Medicaid Medicaid Nurses 58

C&M Health Law

NOVEMBER 7, 2022

CMMI has broad statutory authority not only to test, design, and implement health care payment and delivery models for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) but in certain instances, can implement such models without Congressional action. Potential directions CMMI may take to lower drug costs.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

JANUARY 9, 2023

The Health Insurance Portability and Accountability Act was signed into law in 1996 and while there have been some significant HIPAA updates over the last two decades, the last set of major HIPAA updates occurred in 2013 with the introduction of the HIPAA Omnibus Final Rule. In each category, a maximum penalty of $1.5

HIPAA 111

HIPAA COVID-19 COVID-19 Vaccine Compliance 111

Health Populi

JUNE 18, 2020

By demographics, more women than men are concerned about rising costs for the three health care spending categories the survey studied: drug prices, insurance premiums, and healthcare costs (medical care services spending). Across-the-board, nonwhites are more concerned than whites on the three spending categories, as well.

Prescription Drug Pricing 78

Prescription Drug Pricing COVID-19 Medicaid Medicaid 78

Health Populi

AUGUST 16, 2021

adults favor increased government funding allocated to lowering the out-of-pocket costs for patients. For prescription drug manufacturers, several cost line items: providing or maintaining administrative support services, direct financial assistance (like copay cards), and donating drugs to insured patients via patient assistance programs.

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COVID-19 Nurses Doctors Medicaid 131

Health Populi

DECEMBER 25, 2018

This bill would create a government-run drug company to produce and distribute generic medicines. Employers will endeavor to artfully design consumer-directed benefit plans (CDHPs) that nudge insured workers toward healthier habits, while integrating a broader definition of wellness.

Health Insurance 106

Health Insurance Hospitals Doctors Medicaid 106

Kaiser Health News

JANUARY 12, 2023

Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug. They really scrutinized a lot of government contracts — like no-bid government contracts that funneled lots and lots of money to things that did not pan out or help anybody. That’s not true.

US Department of Health and Human Services 52

US Department of Health and Human Services FDA Medicare Medicare 52

Kaiser Health News

FEBRUARY 9, 2023

He urged Congress to do more, including making permanent the boosted insurance premium subsidies added to the Affordable Care Act during the pandemic. to achieve universal health insurance coverage, something every other developing nation already has, but we have not yet been able to achieve. But first, this week’s health news.

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US Department of Health and Human Services Medicare Medicare FDA 52