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 ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Populi

JUNE 5, 2022

The good news about prescription drugs, in the context of medical spending in the U.S., But there’s bad news about prescription drugs in the context of medical spending in America. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large health insurance companies.

Overpayments 149

Overpayments Overpayment Medicare Medicare 149

Healthcare IT Today

FEBRUARY 25, 2023

Andy Oram chatted with Abhi Sharma at Loyal about what it takes to make HIPAA-compliant chatbots. Read more… Retrieving Billions in Medicare Overpayments. Andy spoke to Kel Pults at MediQuant about the importance of maintain high-quality, measurable, and reportable data. Making Machine Learning Work With HIPAA.

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Overpayments Overpayment Ransomware Medicare 102

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

Healthcare IT News - Telehealth

JUNE 8, 2022

based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. If Medicare coverage requirements for telehealth services (e.g., If Medicare coverage requirements for telehealth services (e.g.,

US Department of Health and Human Services 175

US Department of Health and Human Services Compliance Overpayments Overpayment 175

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 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Compliancy Group

FEBRUARY 7, 2024

You may have been hearing about UPIC (Unified Program Integrity Contractor) audits more often lately. This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. Who Should Be Concerned About CMS UPIC Audits?

Fraud 52

Fraud Compliance Medicare Medicare 52

Healthcare IT Today

JANUARY 17, 2024

External Audits Surge Among the report’s standout findings is the significant uptick in external payor audits in 2023, a result of escalating federal government efforts to address the overpayments made in the past two to three years. Moreover, extended adjudication times (29-35 days) for initial responses to claims impacted cash flows.

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Compliance Overpayments Overpayment Medicare 106

YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). The inflated charges resulted in inappropriate outlier payments from Medicare.

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

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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Fraud Medicare Medicare Overpayments 62

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.

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Compliance Overpayments Overpayment Compliance Officers 52

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

Healthcare IT Today

FEBRUARY 2, 2023

As proof, several health plans have been making headlines for coding errors and other issues that surfaced during audits: In just the third quarter of 2022, at least four audits have specifically targeted Medicare Advantage plans. The New York Times claimed eight of the 10 largest Medicare Advantage insurers had padded their bills.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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

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

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

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

YouCompli

OCTOBER 26, 2022

The review found providers often did not meet the Medicare billing requirements – a whopping 83 of 200 were in error. That’s a 41% error rate with an extrapolated overpayment of?$269 Yes, you and these other departments can assist if there are questions about interpreting a regulation. 269 million.?.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

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. A great free modifier resource to share with you is the CMS Medicare Administrative Contractor (MAC) “WPS” learning center with on-demand training materials.

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

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: (..)

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

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

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

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. But first, learn more about how a complex payer audit system works. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Audited by a payer?

Medicare 52

Medicare Medicare Compliance Governance 52

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

Hall Render

APRIL 18, 2022

CMS plans to increase Medicare reimbursement for SNFs by 3.9% reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare. According to new employment data, about 3 million people in the U.S. The Public Health Emergency has been in effect since January 27, 2020. in fiscal year 2023.

Public Health 40

Public Health COVID-19 Overpayments Overpayment 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

JANUARY 19, 2024

PPP Loan Travel nurse speaks out about assault at MU Psychiatric Center, subsequent treatment MONTANA Montana boosts pay, adds bonuses for health facility employees Negotiations between St. Bipartisan Ky.

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 health dept. processed 1.5

Nursing Homes 40

Nursing Homes US Department of Health and Human Services 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”). Health Equity in Medicare Advantage. We’ve summarized some of the key changes in the Proposed Rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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. billion recovered relating to Medicare fraud alone. In 2021, 97 non qui tam cases were investigated and $3.59

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HIPAA Fraud Health Insurance Health Care Reform 121

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. Delaware retirees protest switch to Medicare Advantage plan. Medicare cuts concern Kentucky home health leaders. About 5% of N.J.

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

NATIONAL 340B repayments welcomed but concern remains, hospital group says 4 pieces of legislation fighting to alleviate the physician shortage crisis AHA Files Lawsuit Challenging HHS Guidance on Tracking Technologies AHA says 3.1%

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40