Modern Healthcare

JULY 28, 2022

An OIG audit outlined millions in uncollected overpayments, holes in internal accounting system

Overpayments 116

Overpayments Overpayment Medicare Medicare 116

Fierce Healthcare

NOVEMBER 7, 2022

Payers recover overpayments 50% faster with enterprise technology: study. Mon, 11/07/2022 - 12:43.

Overpayments 94

Overpayments Overpayment 94

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Healthicity

FEBRUARY 8, 2022

In a recent audit of a New York hospital, the HHS OIG identified overpayments. New York Hospital to Pay $389,000 to Medicare.

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. the risk adjusted portion of the MA premium. 29844, 29921 (May 23, 2014).

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs. Background RADV audits are the main tool that CMS uses to correct overpayments made to MAOs.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Fierce Healthcare

SEPTEMBER 30, 2021

Centene to pay more than $71M to settle Medicaid overpayment cases in Illinois, Arkansas. Thu, 09/30/2021 - 16:43.

Overpayments 105

Overpayments Overpayment Medicaid Medicaid 105

Healthcare Dive

FEBRUARY 2, 2023

Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

Overpayments 243

Overpayments Overpayment 243

Healthcare Dive

JUNE 1, 2022

Consumers are overpaying for generic drug prescriptions by as much as 20% due to pharmacy benefit manager practices like copay clawbacks and spread pricing, researchers found.

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Overpayments Overpayment 316

Healthicity

NOVEMBER 29, 2022

Health and Human Services Office of Inspector General (OIG) recently issued a report concluding that Medicare and patients combined overpaid more than a million dollars for the same professional services provided at critical access hospitals (CAH). Who Bills for Professional Services?

Overpayments 52

Overpayments Overpayment Hospitals Medicare 52

Healthcare Law Blog

FEBRUARY 1, 2023

Likewise CMS cited its fiduciary duty to protect taxpayer dollars from overpayments and its fiduciary responsibility to recover funds due to the Medicare Trust Funds. case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. The Court of Appeals reversed and reinstated the Overpayment Rule.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Healthcare IT Today

MAY 2, 2023

Founded in 1995, DCI’s payment integrity services provide millions of dollars of post payment overpayment identifications for clients. DCI has extensive experience in the health care field with over 28 years of experience servicing managed care clients.

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Overpayments Overpayment 118

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. The defendants disagreed.

Overpayments 52

Overpayments Overpayment Medicaid Medicaid 52

The Health Law Firm

FEBRUARY 15, 2016

., Board Certified by The Florida Bar in Health On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule which eased requirements for health care providers to return overpayments within 60 days to avoid False Claims Act (FCA) liability. To read the final rule from CMS, click here.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

NEJM

JANUARY 13, 2023

A 2022 Supreme Court ruling raises questions about the 340B program’s outsized effect on the health care system’s structure and on the role of hospitals in providing care to underserved populations.

Overpayments 51

Overpayments Overpayment Medicare Medicare 51

Healthicity

MARCH 4, 2022

The OIG continues to perform focused audits on hospital claims using billing data from thousands of hospitals.

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Hospitals Overpayments Overpayment Compliance 96

Healthcare IT Today

FEBRUARY 25, 2023

Read more… Retrieving Billions in Medicare Overpayments. Improper payments for Medicare are estimated to exceed $43 billion per year, and determining overpayments in open-ended value-based Medicare Advantage plans poses a problem. Read more… Fixing Medicare Advantage Payments.

Overpayments 118

Overpayments Overpayment Medicare Medicare 118

Health Care Law Brief

APRIL 12, 2023

Notable Omissions from Proposed Rule CMS declined to adopt previously proposed amendments to the standard for “identified overpayments” under Medicare Parts A, B, C, and D. The Social Security Act requires “a person” who has received an overpayment to report and return the overpayment no later than 60 days after being “identified.”

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Modern Healthcare

JULY 25, 2022

Providers that don't participate in the 340B program say CMS's plan would lead to unfair overpayments to 340B providers.

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Overpayments Overpayment 89

Health Law Advisor

FEBRUARY 2, 2023

For these years, CMS will limit payment recoveries to “enrollee-level adjustments,” i.e., the non-extrapolated overpayments identified in CMS RADV audits and Department of Health and Human Services Office of Inspector General (OIG) audits. CMS expects to recover a total of $4.7 This total includes $41.1

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Modern Healthcare

MARCH 17, 2022

As Xavier Becerra approaches his one-year anniversary at HHS' helm, he's interested in working with Congress on Medicare Advantage overpayment issues and physician payment reform.

Medicare 88

Medicare Medicare Overpayments Overpayment 88

Healthicity

APRIL 12, 2022

The OIG’s Annual Workplan for 2022 includes the continuous auditing and monitoring of items and services.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Modern Healthcare

AUGUST 18, 2022

CMS could consider a policy more like the one it used to correct for overpayments to nursing homes, home health leaders said.

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Overpayments Overpayment Nursing Homes Nurses 77

Health Populi

JUNE 5, 2022

., is that 9 in 10 medicines prescribed are generics. They comprise only 3% of all U.S. healthcare spending. But there’s bad news about prescription drugs in the context of medical spending in America. “An analysis by Schaeffer Center researchers found that Medicare Part D standalone drug plans paid $2.6

Medicare 154

Medicare Medicare Health Insurance Overpayments 154

Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-3: Self-Disclosure Program New Subpart 521-3 implements the long-standing requirement that all enrolled Medicaid providers report, return and explain overpayments received from the Medicaid program through OMIG’s Self-Disclosure Program.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

HIT Consultant

AUGUST 22, 2022

Smart Response complements Anomaly’s planned suite of products powered by its AI claim prediction engine, including overpayment prediction, which enables payers to predict and prevent overpayments by learning from previously overpaid claims, and instant payments, which will enable providers to immediately get paid upon claim submission.

Overpayments 52

Overpayments Overpayment Medicaid Medicaid 52

The Health Law Firm

AUGUST 18, 2022

As a result, auditing and subsequent overpayment demands are some very real possibilities. ., Board Certified by The Florida Bar in Health Law Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country.

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Health Care Law Brief

APRIL 3, 2023

In the Advance Notice, CMS predicted that the changes to the risk scores and HCC updates will help prevent overpayments by improving the accuracy of payments made to MAOs. This would effectively make improper coding (due to unsubstantiated medical records or other reasons) an overpayment subject to the FCA. See 88 Fed. 6643 (Feb.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

The Health Law Firm

FEBRUARY 27, 2013

Our firm has been consulted recently by owners of different health care entities, including assisted living facilities (ALFs), group homes, home health agencies and even medical groups that had received Medicaid overpayment demands. This resulted in a Medicaid overpayment assessment.

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

Healthcare IT Today

NOVEMBER 22, 2022

The payer could also recoup the overpayments from future visits. . Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. In a best-case scenario, they can deny payment or ask to be repaid for the visits they found were overbilled during the audit.

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Medicare Medicare Overpayments Overpayment 110

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.

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Medicare Medicare Governance Overpayments 122

Healthcare IT News - Telehealth

JUNE 8, 2022

Additionally, any reimbursement resulting from these claims could be considered an overpayment. Once a provider has credible evidence of an overpayment, it must be reported and returned to avoid triggering FCA liability.

US Department of Health and Human Services 198

US Department of Health and Human Services Compliance Medicare Medicare 198

YouCompli

FEBRUARY 22, 2023

They found the facility correctly billed 17 of the 120 but incorrectly billed the remaining 103 claims, which totaled over $580,000 in overpayments. Return illegitimate reimbursement and overpayments quickly. The government has a 60-day overpayment rule. In this case, the OIG audited a sample of 120 outlier payments.

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Compliance US Department of Health and Human Services Medicare Medicare 52

Healthcare Compliance Blog

MARCH 16, 2022

an overpayment), make all reasonable efforts to determine if inappropriate billing occurred, if any related overpayments exist, and if found, return the funds to Medicare within 60 days of identification. . Periodically audit to ensure that skilled rehabilitation services being provided to residents are reasonable and necessary.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

Natalia Mazina

JULY 3, 2022

This lead to overpayments to pharmacies. For more than 2 years, the DHCS continued to pay pharmacies through the Medi-Cal claims processing system consistent with the rate methodology used prior to the NADAC implementation.

Patient Advocacy 52

Patient Advocacy Overpayments Overpayment Medicaid 52

The Health Law Firm

JANUARY 30, 2020

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law. We have gotten calls from healthcare professionals, including physicians, dentists, pharmacists, mental health counselors, and assisted living facilities (ALFs) who have been placed on prepayment review after failing to challenge Medicare or Medicaid audit results.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40