YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). This means reimbursement is not typically based on charges.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

YouCompli

SEPTEMBER 13, 2023

Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Compliance Fraud 52

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.

Fraud 59

Fraud Compliance Medicare Medicare 59

The Health Law Firm

FEBRUARY 20, 2018

million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. 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.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare IT Today

FEBRUARY 17, 2023

Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. How can such overpayments be uncovered?

Overpayments 93

Overpayments Overpayment COVID-19 Medicare 93

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. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Compliance Medicare Medicare 52

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Mary’s unveils new name, but mission remains unchanged UCHealth sues thousands of patients every year. What they say sets them apart.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Florida Health Care Law Firm

DECEMBER 2, 2021

As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”. Any overpayment retained after this period may create liability under the Civil Monetary Penalties Law and the False Claims Act.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

YouCompli

SEPTEMBER 27, 2023

Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. Since claims are submitted electronically, Medicare and others use a system of claims edits to avoid paying claims inappropriately.

Compliance 52

Compliance Medicare Medicare Overpayments 52

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

Medicare 52

Medicare Medicare Compliance Governance 52

Health Law RX

NOVEMBER 9, 2021

The updated SDP makes several important revisions and clarifications that directly impact providers and suppliers who seek to self-disclose potential violations of healthcare fraud statutes to the government. The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

Hall Render

JANUARY 19, 2024

Francis emergency room KENTUCKY Apollo’s 220-hospital ‘stranglehold’ harms patients and workers, report alleges Humana cuts ‘small’ number of jobs in multiple locations LMU School of Nursing will open Lexington site at CHI Saint Joseph Health Mercy Health announces acquisition of orthopedic center in Paducah, Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M in 256-Slice CT scanner Lifepoint reports $200M+ economic impact in Cen Ky St.

Nursing Homes 40

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

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage. We’ve summarized some of the key changes in the Proposed Rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

MARCH 30, 2022

However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away. billion recovered relating to Medicare fraud alone. It was only when the provisions of a companion bill ( HR.3103 In 2021, 97 non qui tam cases were investigated and $3.59

HIPAA 123

HIPAA Fraud Health Insurance Health Care Reform 123

Hall Render

MARCH 22, 2024

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

Nursing Homes 40

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

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 Medicaid systems are struggling as potential expansion looms Clearly, many state unemployment information systems are in dire need of upgrades. For Medicaid, the threat comes as potential expansion looms. Centers for Medicare and Medicaid Services (CMS) reimbursed states $34.3

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Kaiser Health News

JUNE 29, 2022

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Those trade-offs aside, Medicare Advantage is clearly proving attractive to consumers.

Medicare 105

Medicare Medicare Governance Overpayments 105

Kaiser Health News

OCTOBER 13, 2022

Meanwhile, open enrollment for Medicare begins Oct. 15, when beneficiaries can join or change private Medicare Advantage plans or stand-alone prescription drug plans. Many seniors are happy with their Medicare Advantage plans, which often offer more benefits than traditional Medicare at a reduced cost.

Medicare 67

Medicare Medicare ACA Governance 67