MRO Compliance

JUNE 1, 2022

Information You Need to Know about a HEDIS Audit from Revenue Cycle Experts. Below we explore some common questions about HEDIS and review important information your team should know now and in the future. Below we explore some common questions about HEDIS and review important information your team should know now and in the future.

Medicare 130

Medicare Medicare Compliance Medicaid 130

HIPAA Journal

APRIL 14, 2023

The Iowa Department of Health and Human Services (DHHS) has confirmed that the personal information of 20,800 Iowans who receive Medicaid was exposed in a cyberattack at a subcontractor of one of its business associates between June 30, 2022, and July 5, 2022. Notifications were mailed to affected individuals on April 10, 2023.

Medicaid 91

Medicaid Medicaid Ransomware HIPAA 91

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 80

Medicaid Medicaid Ransomware Health Insurance 80

HIT Consultant

OCTOBER 24, 2023

Tim Taylor, Principal Industry Consultant at SAS Victor Sterling, Principal Industry Consultant at SAS State Medicaid agencies are responsible for health services that touch the lives of every American, making the potential benefits of modern technology tools, such as artificial intelligence (AI) and machine learning (ML), enormous.

Medicaid 78

Medicaid Medicaid COVID-19 78

HIT Consultant

NOVEMBER 16, 2023

What You Should Know: – General Dynamics Information Technology (GDIT) has been awarded a $63M contract by the Alabama Medicaid Agency to modernize the state’s Medicaid program. Modernization Strategy The Alabama Medicaid Agency is pursuing a multi-year strategy to modernize its Medicaid Enterprise System (MES).

Medicaid 52

Medicaid Medicaid 52

HIT Consultant

MARCH 6, 2023

What You Should Know: – CRISP , the nonprofit state-designated health information exchange (HIE) of Maryland, announced plans to expand its Medicaid Redetermination Notification project across the state to support care teams as they navigate redetermination for 1.6 million Medicaid enrollees.

Medicaid 52

Medicaid Medicaid 52

HIT Consultant

AUGUST 31, 2023

Adimika Arthur, Executive Director, HealthTech 4 Medicaid Manisha Sharma, Senior Medical Director, Promise Health Plan Blue Shield of California During the pandemic, Medicaid enrollment grew by nearly 30% to cover more than 93 million Americans , due in large part to COVID-19 provisions that included continuous Medicaid enrollment.

Medicaid 64

Medicaid Medicaid COVID-19 Doctors 64

Hall Render

MARCH 8, 2024

On January 30, 2024, the Centers for Medicare and Medicaid Services (“CMS”) issued a Request For Information (“RFI”) seeking input from interested parties regarding Medicare Advantage (“MA”) data. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Kaiser Permanente

JANUARY 1, 2022

Medicaid and the Children’s Health Insurance Program (CHIP) have served as critical supports to children, pregnant women, parents, seniors, and individuals with disabilities – covering 80 million individuals during the COVID-19 pandemic. Since February 2020, Medicaid enrollment has grown sharply to cover an additional 9.9

Medicaid 92

Medicaid Medicaid Medicare Medicare 92

Foster Swift

APRIL 16, 2024

In both circumstances, the former doctors carried out their sexual abuse under the guise of medical procedures and without the informed consent of their targets. Read More › Tags: Health Care Reform , Hospitals , Lawsuit , Medicare/Medicaid , Privacy

Informed Consent 52

Informed Consent Health Care Reform Doctors Medicaid 52

HIT Consultant

OCTOBER 30, 2023

HHS is committed to developing and implementing policies that discourage information blocking to help people and the health providers they allow to have access to their electronic health information,” said HHS Secretary Xavier Becerra. “We

Medicare 98

Medicare Medicare Payment Systems Hospitals 98

Health Law RX

FEBRUARY 15, 2023

Medicaid providers and suppliers have likely discovered this the hard way. A provider’s or supplier’s enrollment in the Medicaid program may be insufficient to assure that their provision of a covered and medically necessary good or service to a Medicaid patient will be deemed reimbursable. First, get the word out.

Medicaid 52

Medicaid Medicaid Health Care Lawyers Compliance 52

Medisys Compliance

APRIL 19, 2023

The Medicaid program in Florida provides medical services and assistance to low-income individuals and families. To participate in the Medicaid program, healthcare providers must meet several general requirements set forth by the Agency for Health Care Administration (AHCA).

Medicaid 52

Medicaid Medicaid Medical Billing Outsourcing Licensing 52

HIT Consultant

JANUARY 29, 2024

What You Should Know: – HealtheMed , a revolutionary public health utility startup, is empowering underserved Medicaid recipients in Minnesota to live healthier, more independent lives through its innovative Clinic@Home platform. They provide a source of entertainment, information, and escape.

Medicaid 52

Medicaid Medicaid Telemedicine Public Health 52

American Medical Compliance

JUNE 19, 2023

Several states have recently approved the extension of postpartum Medicaid coverage beyond the usual two-month period. By providing extended Medicaid coverage, states are taking a proactive approach to safeguarding the well-being of mothers during this vulnerable period. Visit [link] for more information.

Medicaid 52

Medicaid Medicaid Compliance 52

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

HIT Consultant

JUNE 20, 2023

What You Should Know: General Dynamics Information Technology (GDIT) , a business unit of General Dynamics , announced today that it was awarded a $39M Medicaid Enterprise Benefit Management Services contract by the state of New Mexico to support its Human Services Department (HSD).

Medicaid 52

Medicaid Medicaid 52

Hall Render

APRIL 16, 2024

Department of Health and Human Services (“HHS”), through the Centers for Medicare & Medicaid Services (“CMS”) released a memorandum to state survey agency directors highlighting revisions and clarification to the Hospital Interpretive Guidelines for Informed Consent (the “Guidance”).

Informed Consent 40

Informed Consent Hospitals Compliance HIPAA 40

Healthcare IT Today

APRIL 26, 2023

The following is a guest article by Ashley Perry, MPH, Chief Strategy and Solutions Officer at Socially Determined When Congress passed the Consolidated Appropriations Act of 2023 , it decoupled the Public Health Emergency (PHE) from the Medicaid program’s continuous enrollment provision, which was implemented as part of the PHE in March 2020.

Medicaid 64

Medicaid Medicaid Public Health Health Outcomes 64

Healthcare Compliance Blog

MAY 2, 2022

A behavior analyst who was employed by a Florida home health agency has been arrested for Medicaid fraud. The man provided behavior analyst services for three Medicaid recipients, all of whom had disabilities. The parent of one of the children noticed incorrect information on a Medicaid online portal and reported it.

Medicaid 59

Medicaid Medicaid Fraud Medicare 59

HIPAA Journal

AUGUST 10, 2023

Four more entities have confirmed they were affected by the mass hacks of the MOVEit Transfer file transfer solution and had protected health information stolen. It is currently unclear exactly how many Medicaid recipients were affected. The DSS said all Missouri Medicaid recipients are being notified about the breach as a precaution.

Medicaid 52

Medicaid Medicaid Health Insurance HIPAA 52

Healthcare Law Blog

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] Please refer to our prior blog for more information on CalAIM. ILOSs must be medically appropriate.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

Electronic Health Reporter

FEBRUARY 11, 2019

Department of Health and Human Services (HHS) today proposed new rules to support seamless and secure access, exchange and use of electronic health information. The article HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information appeared first on electronichealthreporter.com.

Medicaid 115

Medicaid Medicaid Medicare Medicare 115

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. Update your policies and procedures as needed.

Fraud 59

Fraud Medicaid Medicaid Medicare 59

Hall Render

DECEMBER 20, 2023

For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency. Public Posting of Data CMS finalized the Proposed Rule’s requirement that the information provided per Section 1124(c) of the Act be publicly available within one year of the Final Rule.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Med-Net Compliance

JUNE 13, 2022

Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that

Fraud 105

Fraud Medicaid Medicaid 105

Hall Render

AUGUST 22, 2023

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. The government also argued that regardless of the Medicaid Act, the representations influenced decision-makers and thus were material and resulted in an FCA violation.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

Health Care Law Brief

FEBRUARY 2, 2024

While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Med-Net Compliance

AUGUST 5, 2022

New York Attorney General Letitia James announced the indictment of a physician and his company for defrauding Medicaid by forcing patients to get unnecessary and invasive medical tests. He then directed his staff to submit claims for payment to Medicaid for those medically unnecessary tests. ?.

Medicaid 59

Medicaid Medicaid Fraud 59

HIPAA Journal

MARCH 16, 2023

Florida Medical Clinic, NorthStar Emergency Medical Services, Denver Public Schools, Wichita Urology Group, and The Bone & Joint Clinic have recently reported hacking incidents and the exposure and potential theft of protected health information. No financial information was compromised, and only 115 Social Security numbers were exposed.

Electronic Medical Records 62

Electronic Medical Records Health Insurance Ransomware HIPAA 62

Healthcare IT News - Telehealth

FEBRUARY 17, 2021

We have a large network that is predominantly Medicaid. Who can see my information? "And before you know it, the new virtual care paradigm solved a lot of other exacerbating issues we had," he continued. "Transportation is huge. "It wasn't a technology issue. It was just an acceptance issue. How do I do it?

Medicaid 205

Medicaid Medicaid COVID-19 Telemedicine 205

Healthcare Law Blog

MAY 16, 2022

More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. It envisions enhanced coordination, integration, and information exchange among managed care plans (MCPs); physical, behavioral, community-based, and social service providers; and county agencies.

Medicaid 59

Medicaid Medicaid Nurses Health Care Access 59

Mobi Health News

SEPTEMBER 13, 2022

The tech giant also announces a partnership between YouTube and the Kaiser Family Foundation that aims to help organizations create high-quality informational content on topics like mental health, maternal care and health inequity.

Medicaid 107

Medicaid Medicaid Medicare Medicare 107

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. Ensure that your policies are reviewed at least annually and updated when new information becomes available.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

Healthcare Compliance Blog

FEBRUARY 2, 2022

The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1 Compliance and Ethics Program, CP 2.3

Nursing Homes 59

Nursing Homes Fraud Medicaid Medicaid 59