Fierce Healthcare

OCTOBER 2, 2023

government that it submitted false and inaccurate Medicare Advantage diagnostic codes in a bid to boost its reimbursement. Cigna will pay $172 million to settle allegations brought by a whistleblower and the U.S. Cigna will pay $172 million to settle allegations brought by the U.S.

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Healthcare Dive

DECEMBER 20, 2022

trillion omnibus spending package as they near a Friday deadline for government funding. Lawmakers are rushing to speed passage of the $1.7

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MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

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MedTrainer

NOVEMBER 14, 2023

While federal operations are slowed, reduced, or put on pause during a government shutdown, healthcare services must continue to operate. What Is a Government Shutdown? Without budget authorization from Congress, a variety of government services and operations come to a halt. But what does this mean for your healthcare business?

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The Health Law Firm Blog

FEBRUARY 8, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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Healthcare IT News - Telehealth

JUNE 19, 2023

Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

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The Health Law Firm Blog

JANUARY 18, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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HIPAA Journal

JULY 31, 2023

a government services contracting company, has announced in a Securities and Exchange Commission (SEC) filing that hackers exploited a zero-day vulnerability in Progress Software’s MOVEit Transfer solution in May 2023 and accessed the protected health information (PHI) of between 8 and 11 million individuals. Reston, VA-based Maximus Inc.,

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Governance Medicare Medicare Ransomware 73

Healthicity

OCTOBER 16, 2023

Medicare Advantage Compliance Under the Spotlight: Lessons from Cigna's $172 Million Settlement $172 million is a lot of money. It's also the amount that the Cigna Group recently agreed to pay to resolve allegations it violated the False Claims Act in relation to its Medicare Advantage (MA) plan enrollees. government joined the action.

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The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

Kaiser Health News

JANUARY 28, 2022

A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursing home care, and no way to challenge a denial. But it can have serious repercussions.

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Healthcare Dive

MARCH 9, 2023

Released Thursday, the budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.

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Prescription Drug Pricing Medicare Medicare Governance 279

Kaiser Health News

AUGUST 3, 2023

Under programs set up by the Affordable Care Act, the federal government cuts payments to hospitals that have high rates of readmissions and those with the highest numbers of infections and patient injuries. For the readmission penalties , Medicare cuts as much as 3 percent for each patient, although the average is generally much lower.

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The Health Law Firm

DECEMBER 4, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one hundred million dollars. Indest III, J.D.,

Fraud 52

Fraud Medicare Medicare Governance 52

The Health Law Firm

DECEMBER 4, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one hundred million dollars. Indest III, J.D.,

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Fierce Healthcare

MARCH 27, 2024

A new report finds that the federal government made nearly $236 billion in improper payments across entitlement programs last year, with Medicare and Medicaid a large source of payment errors. |

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YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

Medicare 52

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Kaiser Health News

FEBRUARY 3, 2022

Under programs set up by the Affordable Care Act, the federal government cuts payments to hospitals that have high rates of readmissions and those with the highest numbers of infections and patient injuries. For the readmission penalties , Medicare cuts as much as 3 percent for each patient, although the average is generally much lower.

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The Health Law Firm

JUNE 17, 2022

Board Certified by The Florida Bar in Health Law On June 15, 2022, the US 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.,

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Medicare Medicare Hospitals Governance 94

Electronic Health Reporter

OCTOBER 19, 2022

By Ken Perez, vice president of healthcare policy and government affairs, Omnicell, Inc. The article The Inflation Reduction Act: The Impact of Medicare Negotiation of Prescription Drug Prices on Hospitals and Health Systems appeared first on electronichealthreporter.com. Illegal copying is prohibited. In August, H.R.

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Medisys Compliance

JUNE 24, 2022

What’s a Medicare Administrative Contractor (MAC)? Its quite common for any provider to get confused while billing to Medicare for healthcare services, as they not billing to Medicare but to a MAC. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims.

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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.

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Governance Department of Veterans Affairs Medicaid Medicaid 52

Medisys Compliance

JULY 5, 2022

What is Medicare Overpayment? Identified overpayments are debts owed to the federal government. A Medicare overpayment exceeds regulation and statute properly payable amounts. When Medicare identifies an overpayment, the amount becomes a debt a healthcare provider owes the federal government.

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Overpayments Overpayment Medicare Medicare 52

The Health Law Firm Blog

NOVEMBER 18, 2023

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., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.]

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Kaiser Health News

FEBRUARY 8, 2022

The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. The total amount of the penalties is determined by how much each hospital bills Medicare.

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Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

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Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

Center for Health Insurance Reform

MARCH 7, 2022

Health insurers reported healthy earnings during the fourth quarter of 2021, thanks in large part to publicly funded programs Medicare and Medicaid. CHIR's Megan Houston reviewed earnings reports for nine major insurers and reports on the key market trends in the health insurance industry.

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Governance Health Insurance Medicaid Medicaid 72

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. 1395w-22(a) ). d)(2) ).

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HIPAA Journal

FEBRUARY 8, 2024

Department of Health & Human Services Office of Inspector General (HHS-OIG) has published a Roadmap for New Physicians on avoiding Medicare and Medicaid fraud and abuse. The post Advice for New Physicians on Avoiding Medicare and Medicaid Fraud and Abuse appeared first on HIPAA Journal.

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Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. Eligible services.

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The Health Law Firm Blog

AUGUST 23, 2022

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., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.].

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Medicare Medicare Hospitals Governance 52

Medisys Compliance

JULY 25, 2022

Recently published watchdog report found that private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. For detailed understanding we shared observations of OIG where they found that some of the claims were wrongly denied by private Medicare plans.

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NCG Medical Blog

AUGUST 8, 2022

If your medical practice treats patients covered by Medicare, then you already know there are countless regulations you need to closely adhere to in order to avoid any issues with the government.

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Medicare Medicare Governance Medical Billing 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7

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Healthcare Law Today

DECEMBER 15, 2022

The case asks whether the government has authority to dismiss an FCA suit after initially declining to proceed with the action, and if so, what standard would apply. Petitioner-Relator Polansky is a doctor and former consultant for Executive Health Resources (EHR), a company that submits claims to Medicare on behalf of health care providers.

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Governance Doctors Medicare Medicare 52

HealthIT Answers

NOVEMBER 14, 2022

By Jordan Rau - The federal government has eased its annual punishments for hospitals with higher-than-expected readmission rates in an acknowledgment of the upheaval the covid-19 pandemic has caused, resulting in the lightest penalties since 2014.

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