The Health Law Firm Blog

APRIL 18, 2022

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].

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Licensing Medicaid Medicaid Fraud 40

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.

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Medicaid Medicaid Ransomware Health Insurance 81

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).

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Medicaid Medicaid Medical Billing Outsourcing Licensing 52

Bill of Health

OCTOBER 19, 2023

The traditional model for post-graduate education for medical students, called residency, is regulated by the Accreditation Council for Graduate Medical Education ( ACGME ) and largely funded by the Center for Medicare Services (CMS). There is an urgent need for Congress to ensure this funding through the Center for Medicare Services.

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Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

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Medicare Medicare Licensing Malpractice 40

MedTrainer

MARCH 30, 2024

Built-in Automation Keep the enrollment process moving forward with automated reminders for providers to send documents, notification of recredentialing deadlines, and license expiration. Choose software with dynamic graphs that show application age, average time to complete applications, and number of closed applications per credentialer.

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Malpractice Licensing Medicaid Medicaid 98

The Health Law Firm

FEBRUARY 14, 2022

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Additionally, the doctor indicated that he was sought to directly address CMS and the Medical Practice's ability to bill Medicare and Medicaid. Indest III, J.D.,

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Medicare Medicare Fraud Doctors 52

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How do people end up on the Medicaid Exclusion List, what are the consequences of being on the list, and can you ever get off the list?

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Medicare Medicare Fraud HIPAA 52

The Health Law Firm Blog

OCTOBER 5, 2023

Board Certified by The Florida Bar in Health Law Do you have a medical, pharmacist, counselor, or nursing license in more than one state? Do you have a license in more than one profession? By George F. Indest III, J.D., Have you been notified that an investigation has been opened against your professional [.]

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The Health Law Firm

DECEMBER 23, 2019

Board Certified by The Florida Bar in Health Law Healthcare professionals: Have you ever had discipline on your professional license during your career? Have you ever been assessed a repayment or fine by Medicare or Medicaid Programs or had your participation in that program terminated or suspended? Indest III, J.D.,

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Medicaid Medicaid Medicare Medicare 40

Healthcare IT News - Telehealth

NOVEMBER 10, 2020

Prepare Now for Anticipated Changes to Medicare and Private Payer Rules. The Centers for Medicare and Medicaid Services (CMS) is expected to issue new rules for telehealth in the release 2021 Physician Fee Schedule later this year. Today, Medicare reimburses for specific services when delivered via live video.

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Public Health Medicare Medicare COVID-19 140

Medisys Compliance

APRIL 11, 2024

Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can now directly bill Medicare for services they furnish and diagnose. This milestone represents a major victory for the mental health professions, expanding access to much-needed care for Medicare beneficiaries and offering exciting new possibilities for MFTs and MHCs.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. Eligible services.

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COVID-19 Medicare Medicare Medical Billing 52

Verisys

MARCH 8, 2024

Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Peters Physician Pleads Guilty to False Statements, Resulting in $1.4

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Fraud Medicaid Medicaid Medicare 52

The Health Law Firm Blog

JULY 11, 2022

Board Certified by The Florida Bar in Health Law Do you have a medical, pharmacist, counselor, or nursing license in more than one state? Do you have a license in more than one profession? By George F. Indest III, J.D., Have you been notified that an investigation has been opened against your professional [.].

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Licensing Nurses Medicaid Medicaid 52

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

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Medicaid Medicaid Medicare Medicare 52

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

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Fraud Medicaid Medicaid Medicare 52

Healthcare IT News - Telehealth

APRIL 10, 2020

The Centers for Medicare and Medicaid Services has temporarily suspended several regulations to enable hospitals, clinics and other providers to boost their front-line medical staff during the coronavirus pandemic.

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Nurses Medicare Medicare Licensing 210

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Providers also need an NPI to enroll in Medicare.

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Fraud HIPAA Medicare Medicare 97

Medisys Compliance

JUNE 20, 2022

Under Fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. Medicare Coverage. In case any assistance needed for Medicare medical billing services, contact us at info@medisysdata.com/ 302-261-9187.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

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Medicare Medicare Licensing Health Insurance 52

NY Health Law

FEBRUARY 13, 2024

On January 9, 2024, the federal Centers for Medicare and Medicaid Services (CMS) finally approved New York State’s 1115 waiver amendment to establish the New York Health Equity Reform (NYHER) Program. Workforce: Workforce investments with a goal of equitable and sustainable access to care in Medicaid.

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Medicaid Medicaid Nurses Medicare 52

Healthcare It News

OCTOBER 31, 2022

" Since HL7 pledged to share the standards free of charge under licensing terms, many partnerships and collaborations with both public and private healthcare entities have bloomed.

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Healthcare IT News - Telehealth

JANUARY 25, 2021

According to a press statement from Thompson's office, it would: Eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establishing the patient’s home as an eligible distant site. This is a common-sense step to make sure our policies keep pace with our technology," he added.

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COVID-19 Medicare Medicare Telemedicine 206

The Health Law Firm Blog

JULY 26, 2023

Board Certified by The Florida Bar in Health Law Many healthcare professionals are unaware of the adverse long-term collateral effects of Medicare revocation or exclusion on their careers and future employment. By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

The Health Law Firm

MAY 12, 2015

Have you ever had discipline on your license as a health professional? Have you ever been assessed a repayment or fine by the Medicare or Medicaid Programs? If so, then you may have also been terminated from or excluded from the federal Medicare Program or your state Medicaid Program. Indest III, J.D.,

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The Health Law Firm Blog

JUNE 27, 2023

Board Certified by The Florida Bar in Health Law Many healthcare professionals are unaware of the adverse long-term collateral effects of Medicare revocation or exclusion on their careers and future employment. By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

The Health Law Firm Blog

JUNE 9, 2023

Board Certified by The Florida Bar in Health Law Many healthcare professionals are unaware of the adverse long-term collateral effects of Medicare revocation or exclusion on their careers and future employment. By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. However, such allowance is not extended beyond March 31, 2023.

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Medicare Medicare Compliance Public Health 52

The Health Law Firm Blog

MAY 17, 2023

Board Certified by The Florida Bar in Health Law Many healthcare professionals are unaware of the adverse long-term collateral effects of Medicare revocation or exclusion on their careers and future employment. By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

The Health Law Firm Blog

MAY 12, 2023

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]

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Medicaid Medicaid Fraud Licensing 52

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. 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 40

The Health Law Firm

OCTOBER 31, 2019

According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice medicine. billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The vast fraud scheme totaled $2.1 This appears to be a new national record.

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Compliancy Group

DECEMBER 15, 2023

Unfortunately, some Medicare and Medicaid funds are lost to fraudulent and wasteful behaviors. Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. Federal healthcare funds help improve overall well-being.

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Fraud Medicaid Medicaid Medicare 52

MRO Compliance

JUNE 1, 2022

HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Depending on the score of a health plan, payers may receive considerable Medicare financial incentives if a score exceeds a certain level. HEDIS audits are important for Medicare and Medicaid health plans.

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Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”).

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MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

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