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. However, if you are a physician, dentist, nurse, mental health counselor, psychologist, pharmacist, physician assistant, nurse [.]

Medicare 52

Medicare Medicare Nurses Overpayments 52

Healthcare IT Today

NOVEMBER 22, 2022

The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. Tricare and Medicare).

Medicare 95

Medicare Medicare Overpayments Overpayment 95

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.’ million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

APRIL 19, 2024

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 Can lawmakers do anything about it?

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Healthcare IT Today

FEBRUARY 17, 2023

Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. 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?

Overpayments 93

Overpayments Overpayment COVID-19 Medicare 93

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. 2018 Medicare Fee-For-Service improper payment rate is lowest since 2010 Significant progress in saving $4.59B in estimated improper payments for the Medicare Fee-For-Service program.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. 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.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

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

Hall Render

FEBRUARY 23, 2024

And lawmakers are trying to help.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

The Health Law Firm Blog

APRIL 19, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]

Malpractice 52

Malpractice Overpayments Overpayment Licensing 52

The Health Law Firm Blog

MARCH 14, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

JANUARY 12, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly [.]

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

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”). Skilled Nursing. CMS states a temporary adjustment is necessary to offset this overpayment. Discipline.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

The Health Law Firm Blog

DECEMBER 19, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 18, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly [.].

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JANUARY 24, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]

Malpractice 52

Malpractice Overpayments Overpayment Licensing 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. Since claims are submitted electronically, Medicare and others use a system of claims edits to avoid paying claims inappropriately.

Compliance 52

Compliance Medicare Medicare Overpayments 52

Hall Render

APRIL 18, 2022

The Public Health Emergency was extended, CMS proposed a small increase in skilled nursing facility (“SNF”) reimbursement rates and South Carolina is pushing to repeal its certificate of need (“CON”) law. CMS plans to increase Medicare reimbursement for SNFs by 3.9% in fiscal year 2023.

Public Health 40

Public Health COVID-19 Overpayments Overpayment 40

Hall Render

JANUARY 19, 2024

Did it work? Workers at another D.C.

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

Nursing Homes 40

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

Hall Render

OCTOBER 7, 2022

10 states with the largest decreases to travel nurse pay. How tight nursing home capacity is bottlenecking hospital operations. Judge orders Anthem to face lawsuit over alleged Medicare overpayments. The Ensign Group Acquires Skilled Nursing Facility in Arizona. Congress gives rural hospitals a reprieve, for now.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

NOVEMBER 10, 2023

Million to Settle Kickback Allegations Florida nursing home staffing changes opposed Leapfrog Group releases safety grades for Central Florida hospitals. Million to Settle Kickback Allegations Florida nursing home staffing changes opposed Leapfrog Group releases safety grades for Central Florida hospitals. See who got an A.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MARCH 22, 2024

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

Nursing Homes 40

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

Hall Render

MARCH 15, 2024

NATIONAL 3 things to expect from the pharmaceutical supply chain in 2024 Absence of AI hospital rules worries nurses American Academy of Dermatology votes to keep its diversity policies after anti-DEI proposal Are digital health partnerships replacing M&A?

US Department of Health and Human Services 40

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

Med League

MARCH 23, 2022

Upcoding Fraud: Upcoding is a kind of medical billing fraud that occurs when a provider sends a bill to Medicare or another payor for a more expensive service than the one actually performed. The sum of reimbursements for each code paid separately is higher than the reimbursement for the comprehensive code, causing an overpayment.

Medical Billing 40

Medical Billing Fraud Overpayments Overpayment 40