The Health Law Firm

OCTOBER 9, 2013

Board Certified by The Florida Bar in Health Law The University of Miami Hospital allegedly owes Medicare $3.7 According to a letter from the University of Miami Hospital’s Chief Financial Officer (CFO), the hospital is contesting the Inspector General’s method for calculating the amount of the alleged overpayment.

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Overpayments 40

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

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Healthcare Compliance Blog

MARCH 16, 2022

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

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Nursing Homes Nurses Overpayments Overpayment 59

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

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. This is the reality for a medical company in Minnesota.

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AIHC

SEPTEMBER 30, 2024

Medicare & the OIG are performing Risk Adjustment audits, are you? This was originally mandated by the Centers for Medicare & Medicaid Services (CMS) back in 1997 and implemented in 2004. The OIG made the following recommendations to Humana: Refund to the Federal Government the $6.8

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Overpayments Overpayment Compliance Medicare 52

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). The inflated charges resulted in inappropriate outlier payments from Medicare.

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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 [.]

Medicare 40

Medicare Medicare Hospitals Governance 40

AIHC

FEBRUARY 17, 2025

There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. The list of terms and definitions used throughout are below for reference.

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Fraud Compliance Overpayment Overpayments 52

Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. SNF billing compliance refers to the adherence to federal and state regulations governing billing processes for skilled nursing facilities.

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Compliance Medical Billing Outsourcing Medicare Medicare 52

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.

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Overpayments Overpayment Medicaid Medicaid 40

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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Fraud Medicare Medicare Overpayments 67

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

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

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HIPAA Fraud Health Insurance Health Care Reform 136

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.

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Fraud Compliance Medicare Medicare 59

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 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

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.

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Compliance Overpayments Overpayment Medicare 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

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Fraud Overpayments Overpayment Governance 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.

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US Department of Health and Human Services Compliance Officers Fraud Compliance 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. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

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Fraud Medicare Medicare Compliance 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. 2021, January 15).

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Fraud Compliance Health Insurance Medicaid 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. 2021, January 15).

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Fraud Health Insurance Medicaid Medicaid 52

AIHC

OCTOBER 23, 2024

Defined Criteria” are standards identified in advance and approved for use in a specific audit, generally set by government rules, regulations or government agencies, such as CMS or pre-approved by the governing board of your organization. Corrective action includes refunding overpayments revealed during the audit.

Compliance 52

Compliance Overpayments Overpayment Medicaid 52

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.

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COVID-19 Telemedicine Informed Consent Compliance 59

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.

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Medicare Medicare Governance Overpayments 106

YouCompli

OCTOBER 26, 2022

The net of it is this: Our Compliance Department performed a compliance audit related to sleep studies that resulted in a significant payback to the federal government that could have been avoided if monitoring was being performed by the Sleep Center Clinical leadership. That’s a 41% error rate with an extrapolated overpayment of?$269

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Compliance Compliance Officers Overpayments Overpayment 52

Hall Render

NOVEMBER 25, 2024

When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, the claim submission form includes certifications that the claimed services were provided in compliance with all applicable statutes, regulations and rules.

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Nurses Compliance Compliance Officers Medicare 40

Hall Render

DECEMBER 11, 2024

The Proposed Rule would revise the section governing exclusions under section 1128(b)(14) of the Act based on an individual’s default on a health education loan or scholarship obligation.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Healthcare IT News - Telehealth

JUNE 8, 2022

Additionally, several telehealth flexibilities (that generally expand Medicare coverage for telehealth services) have been extended 151 days (about five months) beyond the termination of the HHS PHE. State government executive orders. If Medicare coverage requirements for telehealth services (e.g., Agency enforcement discretion.

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US Department of Health and Human Services Compliance COVID-19 Overpayments 209

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 billion on their MES and eligibility and enrollment systems, according to a 2020 report by the Government Accountability Office (GAO). Centers for Medicare and Medicaid Services (CMS) reimbursed states $34.3 billion during the pandemic. billion of that amount.

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Medicaid Medicaid COVID-19 Overpayments 52

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.

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Medicare Medicare Medicaid Medicaid 52

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?

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Overpayments Overpayment COVID-19 Medicare 85

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.

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ACA Medicare Medicare Governance 74

Hall Render

FEBRUARY 23, 2024

NATIONAL 382 rural hospitals cut chemotherapy, breakdown by state 1 year after Amazon-One Medical deal finalized: What’s happened since ACOs want increased participation of long-term and post-acute care providers ‘Behind the times’: DC tries to catch up with AI’s use in health care CMS finalizes DSH payment cuts for some safety-net hospitals: (..)

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

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Nursing Homes Nurses Hospitals Medicaid 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

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