The Health Law Firm

JULY 26, 2012

On July 2, 2012 the Officer of Inspector General (OIG) released its Medicare compliance review of West Florida Hospital in Pensacola. According to the audit, the hospital complied with Medicare billing requirements for the documentation majority of inpatient and outpatient claims. Official Break Down of the Audit.

Medicare 40

Medicare Medicare Compliance Overpayment 40

HIT Consultant

JUNE 12, 2024

Revolutionising the Assistance of Patients with Substance Use Disorder Founded in 2010, Lionrock Recovery was an early pioneer in virtual substance abuse counseling. By expanding into IOP for SUD, Brightside Health is now positioned to serve an even larger segment of mental health patients.

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Medicaid Medicaid Medicare Medicare 98

HIT Consultant

JUNE 26, 2024

– Founded in 2010, Foodsmart supports those facing chronic disease and food insecurity by partnering with health plans and providers to give patients access to personalized and affordable healthy eating options. Terms of the transaction were not disclosed. Currently, Foodsmart serves over 2.2

Health Outcomes 105

Health Outcomes Medicaid Medicaid Medicare 105

Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. Medicare Part D will have three (3) phases instead of four (4) – Deductible, Initial Coverage Phase and Catastrophic Phase. generics) in the catastrophic phase.

Medicare 52

Medicare Medicare Compliance FDA 52

The Health Law Firm

SEPTEMBER 12, 2012

The report focuses on the nation’s mental health clinics that overbilled Medicare in 2010, some by tens of millions of dollars. Big Busts in Two South Florida Mental Health Clinics for Medicare Fraud. The majority of these clinics were located in South Florida, Texas and Louisiana.

Fraud 40

Fraud Medicare Medicare 40

Healthcare IT Today

AUGUST 26, 2022

When VBC programs were expanded as part of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, there was hope that the existing fee-for-service model would begin to decline.

Health Outcomes 107

Health Outcomes Medicare Medicare 107

The Health Law Firm

OCTOBER 9, 2013

Board Certified by The Florida Bar in Health Law The University of Miami Hospital allegedly owes Medicare $3.7 This is according to an audit report of the hospital’s billing practices that found the hospital allegedly overbilled the health care program in 2009 and 2010. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Overpayment 40

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. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.

Medicare 52

Medicare Medicare Overpayment Overpayments 52

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.

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Medicare Medicare Overpayment Overpayments 20

Compliancy Group

DECEMBER 13, 2024

For example, some medical identity thieves take insurance information and make fraudulent claims to Medicare or Medicaid for services or goods. Handling sensitive data like Social Security numbers, insurance coverage or enrollment information, names, or credit card numbers always puts an organization at risk for identity theft.

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Compliance Officers Compliance Electronic Medical Records Fraud 94

Medval Compliance Blog

SEPTEMBER 29, 2021

by Frank Fairchok, Vice President of Medicare Reporting Services. The update reads as follows: “ September 27, 2021 – Section 111 Medicare Secondary Payer (MSP) Records Will Accept Future Effective Date. The most common way individuals become Medicare beneficiaries is through action taken by the Social Security Administration.

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Medicare Medicare 52

HIPAA Journal

JUNE 14, 2023

The ransomware attack prevented the hospital from submitting claims to insurers, Medicare, and Medicaid for months, piling even more financial pressure on the already struggling St. The ransomware attack itself did not trigger the closure, but it did play a key part in the decision to close. Margaret’s Health.

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Ransomware Hospitals COVID-19 HIPAA 106

Healthcare IT Today

FEBRUARY 7, 2024

According to Dr. Colin Banas, chief medical officer at DrFirst , they initiated EPCS in 2010, partnering with the Massachusetts Department of Health. Kelly says that a federal bill in 2021 required EPCS for Medicare prescriptions. How do you transmit the prescription to the pharmacy and record it in the PDMP?

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Telemedicine COVID-19 Doctors Medicare 126

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Victor Sterling, Principal Industry Consultant at SAS.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

OCTOBER 21, 2022

However, in 2015, Congress partially relented its stance by passing the Medicare Access and CHIP Reauthorization Act which requires the Centers for Medicare and Medicaid to remove Social Security Numbers from Medicare cards and replace them with Medicare Beneficiary Numbers.

HIPAA 106

HIPAA Compliance Medicare Medicare 106

Jane Sarashon

FEBRUARY 27, 2024

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

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ACA Prescription Drug Pricing Health Insurance Hospitals 118

The Health Law Firm

NOVEMBER 25, 2019

According to federal prosecutors, the eye doctor billed patients and insurance companies for millions of dollars for surgeries that he never performed from 2010 to 2017. Indest III, J.D., Prosecutors also announced that they will sue his practice, The Eye Associates Group, in civil court under the False Claims Act (FCA). The Indictment.

Fraud 40

Fraud Doctors Medicare Medicare 40

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. The release of FHIR in the mid-2010 decade changed everything. The Dilemma of Prior Authorization Prior authorization, also known as a pre-approval, strikes fear into both patients and providers.

Electronic Medical Records 117

Electronic Medical Records Doctors Governance Medicaid 117

Health Populi

APRIL 2, 2018

The Gallup Poll , fielded in the first week of March 2018, found that peoples’ overall economic and employment concerns are on the decline since 2010, at the height of the Great Recession which began in 2008. While 70% of Americans were worried about economic matters in 2010, only 34% of people in the U.S.

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ACA Health Insurance Public Health Health Outcomes 69

Medisys Compliance

AUGUST 4, 2022

The Centers for Medicare & Medicaid Services (CMS) on June 21, 2022, issued a proposed rule that proposes to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Payment Systems Medicare 59

Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”).

Hospitals 66

Hospitals Medicare Medicare Medicaid 66

Natalia Mazina

APRIL 25, 2023

On another, Medicare Part B recently challenged payments to 340B providers. Medicare reimbursement cut In 2018, CMS implemented a 28.5% Manufacturers’ restricting use of contract pharmacies In 2010, the HHS’s issued guidance that covered entities could use unlimited number of contract pharmacies ( See 75 Fed. 10,272 (Mar.

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US Department of Health and Human Services Medicare Medicare Payment Systems 52

Health Law Advisor

FEBRUARY 3, 2022

Whistleblowers (known as “relators” under the FCA) filed 598 new actions under the qui tam provisions of the FCA in FY 2021, a decrease from the 675 actions filed in FY 2020, and the lowest number of filings since FY 2010. WHISTLEBLOWER ACTIONS AND AWARDS REACH DECADE LOW.

Fraud 52

Fraud COVID-19 Governance Medicare 52

The Health Law Firm

OCTOBER 2, 2013

The providers were accused of fraudulently billing Medicare and TRICARE from 2007 until 2010. Indest III, J.D., Board Certified by The Florida Bar in Health Law A federal whistleblower or qui tam lawsuit against a local physician group has been settled, according to the Orlando Business Journal (OBJ) on September 30, 2013.

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Medicare Medicare 40

Healthcare Compliance Blog

MAY 17, 2022

The National Background Check Program, enacted by legislation in 2010, provides grants to states and territories to assist them in developing and improving systems to conduct federal and state background checks of prospective LTC employees.

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Medicaid Medicaid Medicare Medicare 59

Healthcare Compliance Blog

FEBRUARY 15, 2022

In 2009 and 2010, further improvements were made to the False Claims Act and its whistleblower provisions. Other leading sources include: Combatting the Opioid Epidemic Medicare Advantage Program (Medicare Part C) Unlawful Kickbacks Unnecessary Medical Services Procurement Fraud COVID-Related Fraud Other Fraud Recoveries.

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Fraud Governance Compliance Medicare 59

HIPAA Journal

MARCH 31, 2023

The Centers for Medicare & Medicaid Services (CMS) requires records of healthcare providers submitting cost reports to be retained for a period of at least five years after the closure of the cost report, and that Medicare managed care program providers retain their records for ten years.

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HIPAA Medicare Medicare Compliance 126

HIPAA Journal

MARCH 20, 2025

Causes of Healthcare Data Breaches Healthcare Hacking Incidents by Year Our healthcare data breach statistics show hacking is now the leading cause of healthcare data breaches, although it should be noted that healthcare organizations are now much better at detecting hacking incidents than they were in 2010. 55,000 2011 Indiana WellPoint Inc.

HIPAA 109

HIPAA Ransomware Compliance Hospitals 109

Hall Render

JUNE 29, 2022

On June 9, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a notice seeking public comment on its plan to revise the way information is collected under its voluntary Self-Referral Disclosure Protocol (“SRDP”). CMS will accept comments on the proposed rule through August 8, 2022.

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Medicaid Medicaid Medicare Medicare 72

Innovaare Compliance

FEBRUARY 7, 2022

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to whom the company delegates those obligations.

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Medicare Medicare Compliance Medicaid 52

MedTrainer

JULY 29, 2024

Regulatory compliance includes legal mandates directed by both federal and state governing bodies, including the Occupational Safety and Health Administration ( OSHA ), Centers for Medicare & Medicaid Services ( CMS ), Health Resources & Services Administration ( HRSA ), and the Office of Inspector General ( OIG ) of the U.S.

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Compliance US Department of Health and Human Services Regulatory Compliance Compliance Officers 52

HIT Consultant

NOVEMBER 16, 2022

People over 85 are the most rapidly expanding demographic and the elderly segment of the American population is expected to double in 2030 from 2010. These potentially avoidable hospitalizations roughly cost Medicare over $1 billion annually, not to mention the personal toll on a frail population and their loved ones.

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Nurses Telemedicine Patient Satisfaction Medicare 52

Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. healthcare system since 2010’s Affordable Care Act. Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology.

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Medicare Medicare HIPAA Medicaid 52

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse.

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Fraud Medicaid Medicaid Licensing 52

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse.

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Fraud Medicaid Medicaid Licensing 52

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Affordable Care Act (2010): The ACA introduced the concept of value-based care, emphasizing quality and patient outcomes over quantity of services.

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Compliance HIPAA Telemedicine ACA 52

HIT Consultant

JUNE 5, 2024

The Affordable Care Act of 2010 (ACA) and the Medicare Access and CHIP Reauthorization Act of 2015 put providers on notice that quality of care measures, like reducing hospital readmissions and improving patient outcomes, would take precedence over fee-for-service models.

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Nurses Medicare Medicare Hospitals 52