Jane Sarashon

JUNE 5, 2022

“A growing body of research shows that the federal government and Medicare beneficiaries are also overpaying for generic prescription medications,” t hey explained. The good news about prescription drugs, in the context of medical spending in the U.S., is that 9 in 10 medicines prescribed are generics. healthcare spending.

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Overpayments Overpayment Medicare Medicare 124

Healthcare Compliance Blog

MARCH 16, 2022

Erskine stated, “Nursing home facilities provide important services to our elderly; however, those facilities must uphold the trust placed in them by billing the government only for reasonable and necessary services. Periodically audit to ensure that skilled rehabilitation services being provided to residents are reasonable and necessary.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

HIT Consultant

MARCH 20, 2024

The HHS Office of Inspector General (OIG) recently reported that, from October 2014 through December 2016 , 153 audit reports were issued containing 193 overpayment recoveries totaling $648 million, largely due to errors in medical documentation. million (net) and $4.7 billion from 2023 through 2032, including extrapolation effects.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare IT Today

JANUARY 17, 2024

Insights are also from auditing professional and hospital claims totaling more than $5 billion and denials from commercial and government payors exceeding $150 billion. Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S. healthcare organizations.

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Compliance Overpayments Overpayment Medicare 103

YouCompli

FEBRUARY 22, 2023

Allegedly, the facility also failed to fully reimburse the government for its receipt of these outlier payments after it became aware of the issue. The government alleged these increased charges resulted in the greater number of outlier payments. Return illegitimate reimbursement and overpayments quickly.

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

Healthcare IT News - Telehealth

JUNE 8, 2022

State government executive orders. Additionally, any reimbursement resulting from these claims could be considered an overpayment. Once a provider has credible evidence of an overpayment, it must be reported and returned to avoid triggering FCA liability. Legislation or temporary regulatory flexibilities tied to the PHE.

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US Department of Health and Human Services Compliance Overpayments Overpayment 179

The Health Law Firm

OCTOBER 9, 2013

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

6] Improper payments can be overpayments and underpayments. Overpayments put an MAO at risk in a bid and a one-third financial audit while underpayments consume valuable staff time in resolving provider disputes and can also be a jeopardy in a one-third financial audit.

Medicare 52

Medicare Medicare Overpayments Overpayment 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. Indest III, J.D., Board Certified by The Florida Bar in Health Law On December 22, 2017, Kmart Corporation agreed to pay $32.3

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

Healthcare IT Today

FEBRUARY 17, 2023

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? public in overpayments. They expect to recoup 4.7 billion dollars through this program.

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Overpayments Overpayment COVID-19 Medicare 89

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. Ensure Ongoing Compliance.

Compliance 52

Compliance Due Diligence Fraud Governance 52

Health Law Blog

MAY 22, 2018

The government had accused the two owners of paying illegal kickbacks/bribes to “sober homes” in exchange for the referral of the sober homes’ insured residents to treatment program. If the allegations made by the government are to be believed, the treatment center is an illustration of exactly what intentional fraud looks like.

Fraud 52

Fraud Overpayments Overpayment Licensing 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 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

Innovaare Compliance

MARCH 24, 2024

Inovaare transforms complex compliance processes by designing configurable AI-driven automation solutions so healthcare organizations can collect real-time data across internal and external departments, creating one compliance management system.

Fraud 52

Fraud Health Insurance Compliance Medicaid 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.

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Hospitals Compliance Officers Compliance Overpayments 52

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 [.].

Medicare 52

Medicare Medicare Hospitals Governance 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

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

NOVEMBER 1, 2023

As a result, the department now has to refund several thousand dollars in overpayments and implement a corrective action plan. In tackling the countless regulatory and operational issues for these diverse organization types, he has developed a deep understanding of the business of healthcare and the regulations governing the industry.

Compliance 52

Compliance US Department of Health and Human Services Compliance Officers Overpayments 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. Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Compliance Fraud 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. Common schemes include: Code stacking. This occurs when multiple CPT codes are used to delineate different phases in the genetic testing process—a process often rife with error.

Fraud 62

Fraud Medicare Medicare Overpayments 62

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

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.

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Telemedicine COVID-19 Compliance Informed Consent 59

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.

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Overpayments Overpayment Fraud Medicare 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: (..)

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Nursing Homes Nurses Hospitals Medicaid 40

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

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.  She also claimed the hospital failed to reimburse payors for overpayment stemming from these improperly coded claims. The hospital ultimately settled and agreed to pay $3.3

Compliance 52

Compliance Medicare Medicare Overpayments 52

AIHC

MARCH 28, 2022

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. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

Hall Render

JANUARY 19, 2024

NATIONAL 13 major health systems partner with high schools in $250M Bloomberg initiative Acute Hospital Care at Home data released AI can help identify social determinants of health American Hospital Association Sues Over Updated HIPAA Guidance Bill aims to push price transparency to ASCs Billing for patient messages to clinicians is increasing, study (..)

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 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. It was only when the provisions of a companion bill ( HR.3103 It was not until 2002 that the Privacy Rule was published, and 2003 that the Security Rule was published.

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HIPAA Fraud Health Insurance Health Care Reform 121

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.

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Medicare Medicare Medicaid Medicaid 52

Hall Render

MARCH 22, 2024

Nevada Medicaid must cover abortion services, judge rules Clark County health rankings improve, but physicians per capita still well below U.S.

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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). billion during the pandemic. Consider more CMS oversight : Between 2008 and 2018, states spent a total of $44.1 billion of that amount.

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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.

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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.

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Medicare Medicare ACA Governance 67

Med League

MARCH 23, 2022

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. Billing for Services Not Provided.

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Medical Billing Fraud Overpayments Overpayment 40