The Health Law Firm

AUGUST 20, 2012

Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida. 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). Indest III, J.D.,

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Health Law Attorney

APRIL 22, 2021

The Act extends the temporary suspension of certain mandatory Medicare FFS claim payment reductions until December 31, 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.” Continue Reading ?.

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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. two whistleblowers were the doctor’s former?medical

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Fraud Doctors Elder Abuse Medicare 59

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. MAOs will be required to remit improper payments identified during RADV audits in a manner specified by CMS.

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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.

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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.

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HIPAA Ransomware Compliance Hospitals 111

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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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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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. Jeff Dorkin, vice president of new product development, said that they base analytics on data drawn from Medicare claims, which cover the whole senior population of the U.S.

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Doctors Public Health Medicare Medicare 132

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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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

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. These provisions are effective for services furnished on or after January 1, 2011. For dates of service calendar years 2027-2029, the reduced coinsurance is 10%. Background for Reduced Co-Insurance.

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Medical Billing Medical Billing Outsourcing ACA Medicare 52

Healthcare Law Blog

NOVEMBER 1, 2022

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). See 42 U.S.C.

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Medicare Medicare COVID-19 Public Health 52

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. On January 31, 2023, CMS will begin releasing the results of RADV audits and overpayment demands for payment years 2011 through 2017.

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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 Populi

MAY 20, 2024

By payor, prescriptions per enrollee-member increased fastest for Medicare, as volume grew three times faster than enrollment as members were using more prescriptions — about 35 per enrollee in 2023. By contrast, Medicaid enrollment declines in 2023 saw Rx’s per enrollee up from 9 prescriptions to 10 in 2023.

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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.

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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.

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HIPAA Medicaid Medicaid Medicare 52

Kaiser Health News

JUNE 29, 2022

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Medicare Advantage plans accept a set fee from the government for covering a person’s health care.

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Medicare Medicare Governance Overpayments 107

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. Estimated Medicare Part B Savings From Inflationary Rebates. Assessment of Price and Clinical Benefit of Cancer Drugs in Canada, 2011-2020. JAMA Health Forum. 2023 Jan 6;4(1):e225012.

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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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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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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. Jeremy.Booth@c…. Mon, 04/15/2019 - 19:22.

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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”).

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C&M Health Law

JANUARY 25, 2023

Telehealth Section 4113 of the Act extends certain Medicare telehealth flexibilities that were allowed during the COVID-19 PHE for two years, through 2024. The section ensures that telehealth flexibilities under Medicare are extended for two years, regardless of the status of the PHE.

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Medicaid Medicaid Medicare Medicare 104

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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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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CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. percent from 2011-2016, from $17.6

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