Healthcare Law Today

DECEMBER 15, 2022

The case asks whether the government has authority to dismiss an FCA suit after initially declining to proceed with the action, and if so, what standard would apply. Petitioner-Relator Polansky is a doctor and former consultant for Executive Health Resources (EHR), a company that submits claims to Medicare on behalf of health care providers.

Governance 52

Governance Doctors Medicare Medicare 52

HIT Consultant

MAY 9, 2023

BST was founded in 2012 by a group of MIT-trained experts in data science, including Dimitris Bertsimas, Ph.D., Risk Analytics & Insights – solutions that complement existing actuarial-based modeling by applying interpretable risk models, risk scoring, and prescriptive analytics for commercial and government health plans.

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Governance Medicare Medicare 52

Healthcare Law Blog

JUNE 30, 2022

The FCA allows the federal government to recover fraudulently-obtained federal funds, plus significant additional monetary damages and penalties. In Polansky , the relator filed his FCA claim in 2012 accusing defendants of overbilling Medicare by falsely certifying inpatient services as medically necessary.

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Governance Medicare Medicare 52

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). 3729(b)(1)(A). ” United States ex rel. Healthfirst, Inc. ,

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Overpayments Overpayment ACA Medicare 52

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Medicare Advantage and Part D) for a comprehensive assessment of a health plan’s performance. The CMS star ratings challenge. Why are CMS star ratings important?

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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. Those trade-offs aside, Medicare Advantage is clearly proving attractive to consumers.

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Medicare Medicare Governance Overpayment 107

Provider Trust

MARCH 16, 2022

The Centers for Medicare & Medicaid Services (CMS) requires healthcare organizations to screen against all these sources at least monthly. The SAM.gov database is formerly known as the Government Services Administration’s (GSA) list of Excluded Parties List System (EPLS).

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Medicaid Medicaid Medicare Medicare 52

Kaiser Health News

JULY 11, 2023

Last month, another study in Health Affairs reported substantial growth in nonprofit hospitals’ operating profits and cash reserves from 2012 to 2019 “but no corresponding increase in charity care.” Still, the Government Accountability Office, a congressional watchdog agency, argues that community benefit is poorly defined.

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YouCompli

AUGUST 16, 2023

For example, let’s say there was an audit that identified a billing error which resulted in a six-figure repayment to Medicare. For example, let’s assume you have been made aware that the organization inadvertently billed Medicare for a particular procedure in error (e.g., the wrong procedure code was billed).

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Compliance HIPAA Medicare Medicare 52

Healthcare IT News - Telehealth

JUNE 3, 2021

Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services. Before that, he spent 17 years as CEO of HealthPartners, a cooperatively governed health plan and care system in Minnesota. Isaiah Nathaniel. CIO, Delaware Valley Community Health. Philadelphia.

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COVID-19 Department of Veterans Affairs COVID-19 Vaccine Nurses 116

Kaiser Health News

JUNE 16, 2022

Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation, a report by the nonprofit Health Care Cost Institute found.

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Kaiser Health News

AUGUST 12, 2022

First, it would give the federal government the ability to negotiate prices of some drugs purchased by Medicare beneficiaries, a tool that has long been opposed by the drug industry. The drug pricing provision, estimated to save the government nearly $100 billion over 10 years, would require the U.S. “It’s historic.

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Medicare Medicare Prescription Drug Pricing Governance 95

Bill of Health

JULY 8, 2022

While national exigencies may require the political branches of government to act with expediency, Bickel counsels that the court is able to take more time in decision making and reserve its authority for deciding issues of great long-term import to American society. Bickel underscores the distinction between expediency and principle.

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Governance Public Health Medicaid Medicaid 147

Redox

DECEMBER 4, 2020

Immunization information systems (IIS) have received special focus as part of government health initiatives (Meaningful Use 1 and 2), so every state has one or more: More accurate information about the number of distinct IIS in the US: [link] — Lisa Bari (she/her/hers) (@lisabari) November 17, 2020. The government thought the same.

Public Health 52

Public Health Governance Doctors Medicare 52

New Jersey Healthcare Blog

JULY 22, 2022

907(b), the Department of Human Services, Division of Mental Health and Addiction Services readopted rules that govern the provision of mental health services at inpatient psychiatric hospital units known as short-term care facilities (STCFs). In 2012, N.J.S.A. See proposed new rules N.J.A.C. On May 16, 2022, at 54 N.J.R. 191 (N.J.S.A.

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COVID-19 Vaccine Licensing COVID-19 Public Health 40

Health Populi

APRIL 10, 2019

One of those medicines, insulin, cost a patient $5,705 for a year’s supply in 2016, double what it cost in 2012, according to the Health Care Cost Institute. The study analyzed medical claims for millions of patients, both commercially insured and enrolled in Medicare. Pharmaceutical company executives are testifying in the U.S.

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Prescription Drug Pricing Medicare Medicare Governance 121

Kaiser Health News

DECEMBER 10, 2024

The Biden administration is likely to appeal, although a Centers for Medicare & Medicaid Services representative said in an email that the agency would not comment on the litigation. Previously, the federal government estimated that about 100,000 uninsured people out of the half-million DACA recipients might sign up starting Nov.

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Kaiser Health News

JANUARY 12, 2023

But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug. And of course, the Ways and Means Committee has jurisdiction over most of Medicare in the House.

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US Department of Health and Human Services FDA Medicare Medicare 52

Drug & Device Law

JANUARY 30, 2023

387 (2012), immigration case, again rejected obstacle preemption as giving force to “judicially divined legislative purposes” Nothing in the text of federal immigration statutes “indicates that Congress intended enforcement. . . Davidowitz , 312 U.S. Moran , 536 U.S. Walsh , 538 U.S. Mensing , 564 U.S. United States , 567 U.S.

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FDA Fraud Governance Medicare 72