C&M Health Law

DECEMBER 18, 2023

OIG specifically references the United States Sentencing Commission’s Guidelines that require that an entity’s “governing authority shall be knowledgeable about the content and operation of the compliance and ethics effectiveness of the compliance and ethics program.”

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

Health Law RX

JANUARY 30, 2024

A failure to maintain an effective compliance program may become particularly problematic for companies with business transactions on the horizon as the government increasingly incentivizes business professionals to give compliance a seat at the deal table. The GCPG further explains how to implement these elements.

Compliance 52

Compliance Due Diligence Fraud Governance 52

YouCompli

NOVEMBER 1, 2023

That person holds an entrance conference with the department director, and reviews the documentation against the regulatory requirements, but never communicates with the director about how they provide and document the service for billing purposes. Such a situation would raise concerns about that auditor’s ability to do their work properly.

Compliance 52

Compliance US Department of Health and Human Services Compliance Officers Overpayments 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

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. This three-pronged strategy focuses on educating patients and staff about how to avoid misconduct.

US Department of Health and Human Services 52

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

Healthcare Law Blog

FEBRUARY 9, 2024

Sherman himself had submitted disclosure logs to the OIG), Sherman alleges that it failed to adequately report the arrangements it had with Neonatology Associates or any other private physician groups, or return any alleged overpayments. FOOTNOTES [1] Other Defendants include ChristianaCare Health Services, Inc.,

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Innovaare Compliance

MARCH 24, 2024

They also raised concerns about the fairness and accuracy of the AI algorithms, suggesting that the system might be biased against certain types of providers or services. Some providers argued that the AI system’s decisions were opaque and lacked clear explanations, making it difficult for them to understand and challenge claim denials.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

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

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

Healthcare IT Today

MAY 5, 2023

The surge in genetic testing claims comes with a rise in fraud, waste and abuse across government and commercial payers. About Erin Rutzler As vice president of fraud, waste, and abuse (FWA), Erin is responsible for the oversight and strategic direction of Cotiviti’s FWA solution suite. Common schemes include: Code stacking.

Fraud 62

Fraud Medicare Medicare Overpayments 62

AIHC

SEPTEMBER 5, 2023

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. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

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

MAY 10, 2024

Health Policy Commission still missing key document in Steward sale to Optum Local obesity drug developer lands deal worth up to $600M with Novo Nordisk Mass. Health Policy Commission still missing key document in Steward sale to Optum Local obesity drug developer lands deal worth up to $600M with Novo Nordisk Mass.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

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

AIHC

MARCH 28, 2022

But first, learn more about how a complex payer audit system works. 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.

Medicare 52

Medicare Medicare Compliance Governance 52

Hall Render

JANUARY 19, 2024

PPP Loan Travel nurse speaks out about assault at MU Psychiatric Center, subsequent treatment MONTANA Montana boosts pay, adds bonuses for health facility employees Negotiations between St. Bipartisan 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 health dept. processed 1.5 hospitals involved shortcomings in mental health services.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 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. However, there were concerns about the financial consequences of complying with HIPAA due to the cost of health care for higher-risk individuals and the reduced premiums from small businesses.

HIPAA 119

HIPAA Fraud Health Insurance Health Care Reform 119

Healthcare Law Blog

JANUARY 5, 2023

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

MARCH 22, 2024

NATIONAL 79 percent have positive outlook for senior living and care: NIC 12 key legal issues impacting health systems AHA: 94% of hospitals financially impacted by Change Healthcare’s cyberattack A conversation about the HHS plan on AI in health care A new kind of hospital is coming to rural America.

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 billion on their MES and eligibility and enrollment systems, according to a 2020 report by the Government Accountability Office (GAO). About Brett Furst. billion during the pandemic. Consider more CMS oversight : Between 2008 and 2018, states spent a total of $44.1

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. ” The health plan required patients to have an X-ray first to prove a CT scan was needed.

Medicare 105

Medicare Medicare Governance Overpayments 105

Kaiser Health News

OCTOBER 13, 2022

For the first time, Medicare Advantage plans are poised to enroll more than half of the Medicare population despite allegations that many of the largest insurers are getting billions of dollars in overpayments from the federal government. Questions have been raised about federal payments to the plans.

Medicare 67

Medicare Medicare ACA Governance 67

Med League

MARCH 23, 2022

lie about the staff involved in performing the procedure. The sum of reimbursements for each code paid separately is higher than the reimbursement for the comprehensive code, causing an overpayment. The Government will only pay for medical services that are actually performed or for equipment that is actually delivered.

Medical Billing 40

Medical Billing Fraud Overpayments Overpayment 40