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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The Health Law Firm

APRIL 16, 2012

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. BCBS Florida).

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The Health Law Firm

OCTOBER 19, 2012

Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. In October of 2012, the Centers for Medicare and Medicaid Services (CMS) announced it has discovered errors in its initial calculations. Indest III, J.D.,

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The Health Law Firm

MARCH 4, 2013

A report released by the Government Accountability Office (GAO) on February 27, 2013, announced that Medicare will remain a "high-risk" program with respect to its fraud and waste vulnerability. In 2012, according to the report, CMS let more than $44 billion in improper payments go out. Leider, J.D., The Health Law Firm.

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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. Indest III, J.D.,

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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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The Health Law Firm

JULY 9, 2012

A Pennsylvania man has been charged in a 23-count indictment in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. The charges were announced by the Department of Justice (DOJ) on June 29, 2012. By Miles Indest. Straw" Owner Allegedly Used to Start Ambulance Company.

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The Health Law Firm

OCTOBER 23, 2012

On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. These arrests are part of a nationwide initiative to crack down on theft committed by individuals against Medicare. By Dr. Thu Pham, O.D.,

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The Health Law Firm

OCTOBER 18, 2012

Law Clerk, The Health Law Firm On August 9, 2012, the United States Court of Appeals for the Fifth Circuit, located in New Orleans, Louisianna, affirmed the conviction of a patient recruiter in Texas for Medicare Fraud committed after Hurricane Katrina. The patient recruiter was charged with conspiracy to defraud Medicare.

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The Health Law Firm

JUNE 11, 2012

Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.

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The Health Law Firm

NOVEMBER 2, 2012

A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The man was sentenced on October 5, 2012. Man Used Kickbacks and Illegally Solicited Medicare Beneficiaries in Scheme. The claims were almost all for expensive, high-end power wheelchairs.

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The Health Law Firm

DECEMBER 10, 2012

A Detroit-area registered nurse was sentenced on November 19, 2012, to 30 months in federal prison for his alleged part in a nearly $13.8 million Medicare fraud scheme. Nurse Caught Reportedly Signing False Medicare Claims. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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Healthcare IT News - Telehealth

JULY 18, 2022

"In addition, in 2012, UVA Health launched a remote patient monitoring program to improve patient compliance and clinical outcomes, and to reduce hospital readmissions, hospital length of stay and emergency department visits.

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The Health Law Firm

MAY 4, 2012

Over 100 doctors, nurses and other health professionals were arrested on charges relating to Medicare fraud by federal agents on May 2, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law. The arrests were made in seven cities nationwide, but more than half took place in South Florida.

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The Health Law Firm

OCTOBER 3, 2012

On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration at a Senate Special Committee on Aging. To see the Power Mobility Devices (PMDs) Demonstration operational guide from the Centers for Medicare and Medicaid Services (CMS), click here.

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The Health Law Firm

JUNE 8, 2012

A federal jury convicted two South Florida doctors, one Miami-area therapist, and two other individuals for their participation in a Medicare fraud scheme. The jury reached a decision on June 1, 2012. To see the Department of Justice press release, click here.

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The Health Law Firm

AUGUST 8, 2012

The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice (DOJ), the FBI and the Department of Health and Human Services (DHHS). To see the entire press release from the Department of Justice (DOJ), click here.

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HIT Consultant

MARCH 16, 2023

Jim Collins, President of Medicare MSO Physicians need to keep their billing and coding right to ensure seamless reimbursements from payers. Other than this, some changes in the AI-based solutions used in the healthcare industry and some updates in Medicare payments with respect to chronic care and telehealth services.

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The Health Law Firm

SEPTEMBER 12, 2012

On August 16, 2012, the Office of Inspector General (OIG) released a report on questionable billing by mental health centers. 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.

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The Health Law Firm

FEBRUARY 4, 2016

Board Certified by The Florida Bar in Health Law The Department of Health and Human Services Office of Inspector General (OIG) flagged various Medicare providers as having questionable billing practices for ophthalmology services rendered in 2012. Indest III, J.D.,

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The Health Law Firm

OCTOBER 27, 2015

Board Certified by The Florida Bar in Health Law According to the Department of Health and Human Services Office of Inspector General (OIG), Medicare paid a total of $171 million for ophthalmology services that now warrant further scrutiny. Indest III, J.D.,

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The Health Law Firm

NOVEMBER 9, 2012

On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the US Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources.

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Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

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The Health Law Firm

OCTOBER 25, 2012

Two South Florida doctors, both former medical directors at the mental health care company American Therapeutic Corporation (ATC), will spend 10 years in prison for their part in a $205 million Medicare fraud scheme. A US district judge handed down the sentence on October 1, 2012.

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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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Healthcare IT Today

MAY 18, 2023

Furthermore, the acquisition of BST strengthens MultiPlan’s foothold in large and fast-growing adjacent markets by unlocking the value of its significant and expanding claims flows for in-network commercial, Medicare Advantage and other government programs, property and casualty, and supplemental insurance markets.

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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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The Health Law Firm

NOVEMBER 9, 2012

The Los Angeles Times article, released October 12, 2012, names an official with knowledge of this matter as the source. According to an article in the Los Angeles Times, authorities are looking into reports that CVS has been refilling prescriptions and submitting insurance claims without patients’ permission.

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HIPAA Journal

MARCH 20, 2025

150,000 Settlement 2012 Alaska DHSS $1,700,000 Settlement 2012 Massachusetts Eye and Ear Infirmary and Massachusetts Eye and Ear Associates, Inc. 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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Healthcare IT Today

JUNE 21, 2023

Inflation will push Payers back into the Public Marketplace whether Statewide and Federal Health Exchanges, Medicaid and Medicare Before the pandemic, many payers left statewide health exchanges as they found more ways to become profitable outside of the public market.

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The Health Law Firm

OCTOBER 4, 2012

alleging Medicare fraud against Parrish Medical Center, was dismissed by a US District Judge in Tampa, Florida, on August 15, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law. A whistleblower lawsuit against Blackstone Medical, Inc.,

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Healthcare IT Today

FEBRUARY 20, 2023

in 2025, with upside in 2025 based on the successful resolution of its Medicare Stars Ratings mitigation efforts. About Oak Street Health Founded in 2012, Oak Street Health is a network of value-based primary care centers for adults on Medicare. And we do it all with heart, each and every day. Follow @CVSHealth on social media.

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Hall Render

FEBRUARY 15, 2022

In December 2021, the Office of Inspector General (“OIG”) of the Department of Health and Human Services published an Issue Brief titled “Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than Wholly Owned Settings” (“Brief”)(available here ). Issue Brief Findings.

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HIPAA Journal

MAY 18, 2023

The review of the affected files confirmed they contained information such as names, date of birth, addresses, phone numbers, email addresses, driver’s license numbers, Social Security numbers, diagnoses, disability codes, Medicare ID numbers, and health plan carrier information.

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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 joining Geisinger, she served as Pennsylvania’s secretary of health, where she developed an innovative payment and delivery model for rural hospitals. Isaiah Nathaniel. Philadelphia.

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The Health Law Firm

JUNE 15, 2012

The DOJ announced the settlement on April 20, 2012. Walgreens Allegedly Offered Inducements to Medicare and Medicaid Beneficiaries. The settlement resolves allegations that Walgreens violated the False Claims Act. To view the DOJ's press release concerning the settlement with Walgreens, click here.

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Health Populi

MAY 15, 2018

The top row illustrates that the ACA covered a lot of people with health insurances between 2012 and 2016. The lower row shows that the level of self-rationing due to costs fell across the entire northern section of America, leaving at least 15% of people living in the deeper south to continue to ration in 2016 as they did in 2012.

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