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Wrongly Denied Claims by Private Medicare Plans

Medisys Compliance

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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Significant Upcoding Risks Emerge with Medicare Advantage

YouCompli

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.

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Florida woman to pay $20.3M after using telemedicine to shield alleged fraud

Healthcare IT News - Telehealth

Department of Justice announced earlier this month that an Indian Rocks Beach, Florida-based woman has pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return. Department of Health and Human Services Office of Inspector General, in a statement. have also agreed to pay up to $20.3

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How to Prevent Medicare Advantage Fraud, Waste, and Abuse

Provider Trust

US Department of Health and Human Services (HHS) Office of Inspector General Christi A. 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.

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Virtual 40th National HIPAA Summit – Early Bird Discount Ends 2/3

HIPAA Journal

The event provides a tremendous opportunity for learning through HIPAA workforce training sessions and keynote speeches from top government officials and leading industry professionals. These groups cover privacy and HIPAA compliance best practices, HIPAA breach trends, and HIPAA enforcement initiatives and breach trends.

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Hundreds of industry groups call on Congress to advance permanent telehealth reform

Healthcare IT News - Telehealth

"Much of this transformation is dependent on temporary flexibilities extended to health systems and providers that are limited to the duration of the COVID-19 public health emergency declaration," the letter read.

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Florida Home Health Company Pays $2.1M to Resolve False Claims Allegations

Healthcare Compliance Blog

A home health services company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida.