The Health Law Firm

SEPTEMBER 21, 2012

A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Indest III, J.D., Board Certified by The Florida Bar in Health Law. Through this scheme, she allegedly obtained at least $6.1

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Medicaid Medicaid 40

The Health Law Firm

APRIL 22, 2013

Edna Lorraine Watkins, the owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has been sentenced to six years in prison for defrauding Medicaid, according to the Florida Office of the Attorney General (AG). She made more than $400,000 in false claims between January 2008 and June 2011. Watkins was sentenced on April 2, 2013.

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Medicaid Medicaid Fraud 40

HIPAA Journal

MARCH 20, 2025

Dominion National Insurance Company, and Dominion Dental Services USA, Inc. CA Healthcare Provider 2,364,359 Hacking/IT Incident 57 2024 Medical Management Resource Group, L.L.C.

HIPAA 111

HIPAA Ransomware Compliance Hospitals 111

Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. As part of the settlement, the doctor will pay a total of more than $9.48

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Fraud Doctors Elder Abuse Medicare 59

The Health Law Firm

JUNE 11, 2012

The following recent update was released by the Centers for Medicare & Medicaid Services (CMS) on May 30, 2012, updating the original from December 16, 2011: Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from (..)

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Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

SEPTEMBER 19, 2012

The woman was arrested for allegedly stealing money from 11 clients in 2010 and 2011. Investigation by the Medicaid Fraud Control Unit (MFCU) Led to Arrest. To see the press release from the AG, click here.

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Fraud Medicaid Medicaid 40

The Health Law Firm

SEPTEMBER 23, 2013

The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. Indest III, J.D., Board Certified by The Florida Bar in Health Law A group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5

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Fraud Medicaid Medicaid Medicare 40

The Health Law Firm

AUGUST 2, 2012

On July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law. ” To see the official announcement from the CMS, click here.

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Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

AUGUST 20, 2012

This is allegedly due to excessive readmission rates in these hospitals between July 2008 and June 2011, according to the Centers for Medicare and Medicaid Services (CMS). Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida.

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Medicare Medicare Hospitals Medicaid 40

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”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. See also Ratanasen v.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

HIT Consultant

OCTOBER 20, 2023

can be attributed to falls, including approximately six percent of Medicare and eight percent of Medicaid expenditures. Fornari co-founded and was the CEO and medical director of Dominion Diagnostics, one of the country’s leading pharmaceutical monitoring laboratories and served there from 1997 to 2011.

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Pharmaceutical Industry Public Health Medicaid Medicaid 105

Healthcare IT Today

OCTOBER 18, 2023

Data can be spotty, according to Eye, who says for instance that data from Centers for Medicare & Medicaid Services (CMS) often lacks racial identifications. Andrew Eye, CEO of the healthcare data science company ClosedLoop , estimates that about 15% of physicians collect SDoH-related data from patients and use it to assess their needs.

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Doctors Public Health Medicare Medicare 132

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. billion and $11.5

HIPAA 107

HIPAA Compliance Medicare Medicare 107

Health Law Attorney

APRIL 22, 2021

By way of background, the Budget Control Act of 2011 required mandatory across-the-board reductions to be made in federal spending, otherwise referred to as “sequestration.” President Biden recently signed the Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes (the “ Act ”) (available here ) into law.

Medicare 40

Medicare Medicare COVID-19 Medicaid 40

Medisys Compliance

JULY 27, 2022

These provisions are effective for services furnished on or after January 1, 2011. In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies.

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Medical Billing Medical Billing Outsourcing ACA Medicare 52

Health Populi

DECEMBER 7, 2018

These annual numbers come out of the annual report from the Centers for Medicare and Medicaid Services, published yesterday in Health Affairs. After five years of modest premium cost increases between 2011-16, premiums for employer-sponsored health insurance dramatically increased in 2017: for single-person coverage.

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Health Insurance Medicaid Medicaid Medicare 54

Health Care Law Brief

AUGUST 26, 2022

The Centers for Medicare & Medicaid Services (“ CMS ”) recently published the proposed 2023 Physician Fee Schedule (“ PFS ”), which contains several important changes affecting Accountable Care Organizations (“ ACOs ”) that participate in the Medicare Shared Savings Program (“ MSSP ”), including a new Advanced Incentive Program.

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Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

NOVEMBER 1, 2022

On November 1, 2018 , CMS issued a proposed rule that, among other changes, would use extrapolation in RADV contract-level audits of MAOs starting with payment year 2011 contract-level audits and would not apply a FFS Adjuster to such audit findings.

Medicare 52

Medicare Medicare COVID-19 Public Health 52

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. On January 31, 2023, CMS will begin releasing the results of RADV audits and overpayment demands for payment years 2011 through 2017. Experts estimate that the final rule will result in CMS collecting $4.7

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Overpayment Overpayments Medicare Medicare 40

Health Populi

MAY 20, 2024

By contrast, Medicaid enrollment declines in 2023 saw Rx’s per enrollee up from 9 prescriptions to 10 in 2023. Combatting the opioid overdose epidemic has some good news emerging from the medicines sector, with per capita prescribing of opioids down 67% since its apex in 2011.

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FDA Medicaid Medicaid Medicare 71

CMS.gov

SEPTEMBER 22, 2020

On December 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule implementing the Physician Payments Sunshine Act, which was included as section 6002 of the Affordable Care Act of 2010.

Medicaid 20

Medicaid Medicaid Medicare Medicare 20

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

HIT Consultant

FEBRUARY 8, 2023

An open standard called FHIR, which was initially drafted in 2011, makes it easier than ever for legacy systems and new apps to exchange data. Centers for Medicare & Medicaid Services (CMS) finalized a requirement for the use of FHIR by a range of payers and providers subject to CMS regulation starting in mid-2021 in 2020.

HIPAA 52

HIPAA Medicaid Medicaid Medicare 52

Bill of Health

MARCH 17, 2023

Estimates of Medicaid and Non-Medicaid Net Prices of Top-Selling Brand-name Drugs Incorporating Best Price Rebates, 2015 to 2019. Assessment of Price and Clinical Benefit of Cancer Drugs in Canada, 2011-2020. Variation in Use of Lung Cancer Targeted Therapies Across State Medicaid Programs, 2020-2021. JAMA Health Forum.

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Medicaid Medicaid Medicare Medicare 228

Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

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ACA Medicaid Medicaid Compliance 105

Hall Render

FEBRUARY 1, 2024

Regulations implementing the Federal Conscience Statutes date back to 2008 and were narrowed substantially by a 2011 revision (the “2011 Conscience Rule”).

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Compliance Medicaid Medicaid 74

Health Law Advisor

AUGUST 10, 2023

According to the preamble to the 2011 Final Rule: A purchaser of an MDDS who has only used, configured, or modified the MDDS in accordance with the original manufacturer’s labeling, instructions for use, intended use, original design, and validation would not be considered a manufacturer for purposes of this regulation. 10] 76 Fed.

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FDA Licensing Hospitals Medicaid 98

CMS.gov

APRIL 15, 2019

Administrator, Centers for Medicare & Medicaid Services. The SSAs visit and survey every Medicare and Medicaid participating nursing home in the nation at least annually to ensure they are meeting CMS’ health and safety requirements as well as state licensure requirements. Ensuring Safety and Quality in America’s Nursing Homes.

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Nursing Homes Nurses Compliance Medicare 51

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts.

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Medicare Medicare COVID-19 Medicaid 98

New Jersey Healthcare Blog

JANUARY 12, 2022

The change to the Division’s name reflects the merger of the former Division of Mental Health and the former Division of Addiction Services under the Fiscal Year 2010-2011 State Appropriations Act. The Manual extends Medicaid eligibility to certain persons not eligible under the provisions at N.J.A.C.

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Licensing Medicaid Medicaid Nurses 40

CMS.gov

NOVEMBER 2, 2018

Seema Verma, Administrator, Centers for Medicare & Medicaid Services . percent from 2011-2016, from $17.6 CMS BLOG: Medicare for All? Just another name for a government-run, single payer system. keya.joy-bush@…. Fri, 11/02/2018 - 21:32. Medicare Part C. Medicare Part D. November 2, 2018. Medicare for All? billion to $28.0

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Governance Medicare Medicare ACA 55

C&M Health Law

JANUARY 25, 2023

In November 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care At Home program to provide hospitals expanded regulatory flexibility and allow them to care for eligible patients in their homes. These requirements would also apply to state Medicaid fee-for-service programs.

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Medicaid Medicaid Medicare Medicare 104

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 107

Health Populi

NOVEMBER 5, 2018

Governor Kasich has led the Buckeye State since 2011, and his second and final term ends in January 2019. The Governor expanded Medicaid under the Affordable Care Act in the State of Ohio, discussed in this insightful Washington Post article. “I When the Supreme Court made Medicaid expansion optional, Kasich didn’t hesitate.

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Medicaid Medicaid Nursing Homes Nurses 91

Hall Render

MARCH 16, 2022

It’s also the first bicameral legislation to include community project funding (previously known as “earmarks”) since they were banned in 2011. Puerto Rico will receive an additional increase of $200 million if HHS certifies that its state Medicaid plan meets certain requirements.

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COVID-19 Medicare Medicare FDA 40