HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 million (net) and $4.7 billion from 2023 through 2032, including extrapolation effects.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Compliancy Group

FEBRUARY 2, 2024

The DOJ will also determine if there is sufficient communication to employees informing them about the compliance program and garnering commitment to its mission. A CIA allows a healthcare organization to meet certain obligations while maintaining participation in Medicare, Medicaid, and other federal funding programs.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 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. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 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. 2021, January 15). 2021, April).

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). We summarize the key factors and adjustments to the overall expected average rate increase of 3.32% (which is about $13.8

Medicare 52

Medicare Medicare Overpayments Overpayment 52

YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. In fact, the Office of the Inspector General (OIG) has had multiple items about outlier payments on its work plan and has conducted audits in this area. Return illegitimate reimbursement and overpayments quickly.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 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. 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 IT Today

FEBRUARY 2, 2023

These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS). One last note about conducting quality assurance audits: Remember to close the loop.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Med-Net Compliance

OCTOBER 21, 2022

Because the OIG’s assessment of the risk posed by a FCA defendant may be relevant to various stakeholders, including patients, family members, and healthcare sector professionals, the information about where a FCA defendant falls on the risk spectrum is made public.

Fraud 59

Fraud Compliance Medicare Medicare 59

Hall Render

DECEMBER 27, 2023

Specific detail about the exceptions is outlined below. Further, entities should review non-monetary compensation provided in 2023 to ensure that such compensation did not exceed the 2023 limit of $489 and take any necessary corrective action to repay excess amounts within 180 days of the overpayment or by December 31, 2023.

Hospitals 75

Hospitals Overpayments Overpayment Medicaid 75

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. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

APRIL 19, 2024

Can lawmakers do anything about it? to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M health system seeking $150M from state to jumpstart hospital project Pr.

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

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

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Mary’s unveils new name, but mission remains unchanged UCHealth sues thousands of patients every year. What they say sets them apart.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

AIHC

APRIL 5, 2022

If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. Prior to appealing a Medicare, Medicaid, TriCare or other Federal Program claim, you should verify that your organization is compliant in this area ( click here ).

Fraud 52

Fraud Compliance Medicare Medicare 52

Hall Render

DECEMBER 6, 2022

Specific detail about the exception is outlined below. Further, entities should review non-monetary compensation provided in 2022 to ensure that such compensation did not exceed the 2022 limit of $452 and take any necessary corrective action to recover excess amounts within the earlier of 180 days of the overpayment or by December 31, 2022.

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

CMS.gov

NOVEMBER 16, 2018

Administrator, Centers for Medicare & Medicaid Services. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. Fraud, waste, & abuse. Leadership.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS states a temporary adjustment is necessary to offset this overpayment. Behavioral Analysis and COVID-19.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Healthcare Law Blog

MARCH 2, 2023

Effective March 1 st , certain providers choosing to self-disclose Stark Law violations must use forms updated by the Centers for Medicare & Medicaid Services (“CMS”). Once CMS acknowledges receipt of a provider’s SRDP submission, the provider’s obligation to report and return overpayments within 60 days is suspended. See 42 C.F.R.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

AIHC

MARCH 28, 2022

But first, learn more about how a complex payer audit system works. For example, the GAO states that they identified about $77.6 billion in financial benefits in fiscal year 2020— a return of about $114 for every $1 invested. Make sure to read Part 1: Managing Denials is Important to Good A/R Hygiene. Audited by a payer?

Medicare 52

Medicare Medicare Compliance Governance 52

Hall Render

JANUARY 19, 2024

Francis emergency room KENTUCKY Apollo’s 220-hospital ‘stranglehold’ harms patients and workers, report alleges Humana cuts ‘small’ number of jobs in multiple locations LMU School of Nursing will open Lexington site at CHI Saint Joseph Health Mercy Health announces acquisition of orthopedic center in Paducah, Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

AIHC

MARCH 22, 2022

Monitor Reports for Inappropriate Write-Offs Are accounts reconciled and overpayments identified and handled properly? To calculate, divide the dollar amount of accounts receivable that is greater than 120 days by the dollar amount of total current accounts receivable, then multiply by 100.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Hall Render

APRIL 26, 2024

million Medicaid enrollees in 12 months; one month left in ‘unwinding’ University of Maryland Medical Center physicians unionize, a first in the state Emergency room wait times are worse than bad. in 256-Slice CT scanner Lifepoint reports $200M+ economic impact in Cen Ky St. health dept. processed 1.5

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

HIPAA Journal

MARCH 30, 2022

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. the Transactions and Code Sets Rule) and address abuse and fraud in the health care industry to reduce costs to health insurance providers.

HIPAA 119

HIPAA Fraud Health Insurance Health Care Reform 119

Hall Render

AUGUST 26, 2022

CMS bulletin presses states on Medicaid nursing home spending. CMS proposes mandatory Medicaid, CHIP quality reporting. Tie nursing home Medicaid payments to care quality, CMS tells states. Medicaid Contract Remains in Limbo. ‘Not on the same page’: No deal yet on NC Medicaid expansion. NORTH DAKOTA.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). We’ve summarized some of the key changes in the Proposed Rule. Comments on due February 13, 2023. Star Ratings.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

OCTOBER 7, 2022

Judge orders Anthem to face lawsuit over alleged Medicare overpayments. Concerns about kids’ safety at Grand Junction psych hospital prompt state actions. About 5% of N.J. New Mexico seeking payer contracts for 1M Medicaid recipients. Medicaid expansion in sight for North Carolina. The Mental Health Crisis in Utah.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

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

Hall Render

NOVEMBER 10, 2023

Loses Some Defenses In False Claims Case Pa. receives $4.4M

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 Medicaid systems are struggling as potential expansion looms Clearly, many state unemployment information systems are in dire need of upgrades. For Medicaid, the threat comes as potential expansion looms. Centers for Medicare and Medicaid Services (CMS) reimbursed states $34.3

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Hall Render

MARCH 15, 2024

Louis Nursing Home Issued More Fines for Safety, Admin Violations Ascension vs.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Kaiser Health News

JUNE 29, 2022

They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions in suspected overpayments to the health plans, which are run mostly by private insurance companies. CMS is scheduled to release the audits later this year.

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