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

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. 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.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

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

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). CMS will not apply a Fee-For-Service (“FFS”) Adjuster in RADV audits. Becerra et al.,

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Healthcare Compliance Blog

MARCH 16, 2022

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

Healthcare IT Today

MAY 2, 2023

Tech-enabled healthcare BPM organization bolsters payment integrity expertise Sagility LLC , a leading provider of technology-enabled business process management (BPM) services, announced today their acquisition of Chandler, Arizona-based Devlin Consulting, Inc. Synergy Advisors acted as exclusive financial advisor to DCI in this transaction.

Overpayments 100

Overpayments Overpayment 100

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. Indest III, J.D.,

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

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 Fraud Medicare 52

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. CMS also stated in the final rule that it will not apply a Fee-For-Service (FFS) Adjuster in its RADV audits.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Healthcare Law Blog

FEBRUARY 9, 2024

2] Specifically, Sherman alleged that ChristianaCare violated the FCA and DE FCA by providing “in-kind” services to physician groups that were captured in the bundled billing codes submitted to federal health care programs by the groups themselves. ChristianaCare did not admit liability as part of the settlement.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Provider Trust

JUNE 30, 2023

Payers within the healthcare ecosystem understand the complexities and importance of maintaining integrity when submitting or evaluating payments for medical services rendered by providers. This means payers must rely on post-payment reviews and audits to identify those errors, overpayments, and fraudulent claims.

Overpayments 52

Overpayments Overpayment Fraud Compliance 52

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… Improving Service Assurance and Availabilty for Healthcare.

Overpayments 102

Overpayments Overpayment Ransomware Medicare 102

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. Any overpayment retained by a person after the deadline for reporting and returning an overpayment is an obligation under the FCA.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

The Health Law Firm Blog

JANUARY 8, 2024

Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The U.S.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

The Health Law Firm

AUGUST 18, 2022

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. As a result, auditing and subsequent overpayment demands are some very real possibilities. Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Health Law Advisor

AUGUST 25, 2023

New York Social Services Law § 363-d. Social Services Law § 363-d) codified in New York State law federal requirements and OMIG policies require Medicaid providers who have received an overpayment to report, return, and explain the overpayment by making a disclosure to OMIG within sixty (60) days of identifying the overpayment.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

Healthcare IT News - Telehealth

JUNE 8, 2022

The Department of Health and Human Services once again (for the ninth time) extended the public health emergency this past month , stretching it beyond mid-July. But sooner or later, that provision of the Public Health Service Act will draw to a close. More practitioners can provider covered telehealth services (e.g.,

US Department of Health and Human Services 180

US Department of Health and Human Services Compliance Overpayments Overpayment 180

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

Natalia Mazina

JULY 3, 2022

Back in 2017, the California Department of Healthcare Services (DHCS) approved a new methodology – National Average Drug Acquisition Cost (NADAC) – for reimbursing pharmacies for their drug cost. This lead to overpayments to pharmacies. NADAC prices significantly reduced pharmacy reimbursements. See a related blog post.

Overpayments 52

Overpayments Overpayment Patient Advocacy Medicaid 52

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 At the same time, CMS is implementing changes in how its Risk Adjustment Data Validation (RADV) audits are conducted and how their findings lead to overpayment assessments. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare IT Today

NOVEMBER 22, 2022

After all, more patients should generate more billable services—and thus, more payments. 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. What Triggers Audits? .

Medicare 95

Medicare Medicare Overpayments Overpayment 95

Healthcare Compliance Blog

APRIL 14, 2022

Research by the Centers for Medicare & Medicaid Services (CMS) has found that many hospital admissions of dually eligible nursing home residents could have been avoided because the condition could have been prevented or treated outside of an inpatient hospital setting. Update as needed.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

McBrayer Law Blog

NOVEMBER 18, 2020

The estimated overpayment as a result of these coding errors is a reported $1 billion. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims.

Compliance 52

Compliance Overpayments Overpayment Medicare 52

The Health Law Firm Blog

OCTOBER 14, 2022

Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The U.S.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

YouCompli

FEBRUARY 22, 2023

The government is watching these adjustments to make sure they are appropriate for federally reimbursed services. 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.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 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 ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. See 88 Fed. 6643 (Feb.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

DECEMBER 27, 2023

The dollar limit for “medical staff incidental benefits” provided by a hospital to a member of its medical staff ( e.g. , meals, parking and other items or incidental services that are used on a hospital’s campus) is less than $44 per occurrence. and the entity may not bill for such services unless an exception is met.

Hospitals 75

Hospitals Overpayments Overpayment Medicaid 75

Innovaare Compliance

MARCH 1, 2022

1] The Centers for Medicare & Medicaid Services (CMS) has to establish an annual Part B premium that will adequately fund projected Medicare spending and maintain an adequate reserve in case actual costs are higher than estimated. Making proper payments for Part C and D services is also a statutory requirement. [6]

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. Conventional fee-for-service payments, which reimburse a doctor for each visit or other intervention, are hard enough to investigate. public in overpayments.

Overpayments 93

Overpayments Overpayment COVID-19 Medicare 93

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.

Compliance 107

Compliance Overpayments Overpayment Medicare 107

Compliancy Group

FEBRUARY 29, 2024

Department of Health and Human Services (HHS) OIG and the organization. Many companies provide IRO services, including reviews of claims, compliance measures, vetting new hires, and transactions. The Office of Inspector General (OIG) facilitates the development of the Corporate Integrity Agreement between the U.S.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

The Health Law Firm

JULY 6, 2015

for community mental health services. The Chrysalis Center responded on August 23, 2013, by asserting in a letter that one of AHCA's program analysts had previously determined that the vast majority of the services at issue were reimbursable by Medicaid.

Medicaid 40

Medicaid Medicaid Overpayments Overpayment 40

Compliancy Group

FEBRUARY 7, 2024

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. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

Healthcare Compliance Blog

JUNE 9, 2022

His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. Additionally, the Pennsylvania man agreed to be excluded from all federal healthcare programs for 22 years. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

HIT Consultant

JANUARY 9, 2024

They can reduce the burden on clinical and financial staff for payments, disputes, reporting and reconciliations, all while minimizing site and study overall costs and overpayments. About Jim DiCesare Jim DiCesare is passionate about delivering innovative site activation and site payment services to clinical trials.

Overpayments 95

Overpayments Overpayment COVID-19 Fraud 95

The Health Law Firm

JULY 24, 2017

Board Certified by The Florida Bar in Health Law Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. As a result, auditing and subsequent overpayment demands are very real possibilities. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Overpayments Overpayment 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. The Challenge of Health Care Fraud. 2021, April).

Fraud 52

Fraud Health Insurance Compliance Medicaid 52