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).

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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.

Medicare 40

Medicare Medicare Fraud Medicaid 40

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.,

Medicare 40

Medicare Medicare Compliance Overpayments 40

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.,

Medicare 40

Medicare Medicare Hospitals Medicaid 40

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.

Medicare 40

Medicare Medicare Fraud 40

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.,

Fraud 40

Fraud Medicare Medicare 40

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.

Fraud 40

Fraud Medicare Medicare 40

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.

Medicare 40

Medicare Medicare Due Diligence Health Insurance 40

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.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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.

Medicare 40

Medicare Medicare Fraud 40

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.

Nurses 40

Nurses Medicare Medicare Fraud 40

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.

Fraud 40

Fraud Medicare Medicare Medicaid 40

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.

Medicare 40

Medicare Medicare Fraud Medicaid 40

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.

Fraud 40

Fraud Doctors Medicare Medicare 40

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.

US Department of Health and Human Services 40

US Department of Health and Human Services Fraud Medicare Medicare 40

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.

Medical Billing 98

Medical Billing Medicare Medicare Nurses 98

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.

Fraud 40

Fraud Medicare Medicare 40

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.,

Medicare 40

Medicare Medicare 40

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.,

Medicare 40

Medicare Medicare 40

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.

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Hospitals 40

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.

Fraud 40

Fraud Doctors Medicare Medicare 40

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.

COVID-19 173

COVID-19 Telemedicine Electronic Medical Records Hospitals 173

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.

Medicare 52

Medicare Medicare COVID-19 Public Health 52

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.

Governance 108

Governance Health Outcomes Medicare Medicare 108

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 107

HIPAA Compliance Medicare Medicare 107

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.

US Department of Health and Human Services 40

US Department of Health and Human Services Fraud Medicare Medicare 40

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.

Medicare 72

Medicare Medicare COVID-19 Medicaid 72

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.,

Fraud 40

Fraud Medicare Medicare 40

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.

Medicare 97

Medicare Medicare Nurses Health Outcomes 97

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.

Medicare 40

Medicare Medicare Hospitals Compliance 40

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.

Ransomware 100

Ransomware HIPAA Licensing Medicare 100

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.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

OCTOBER 1, 2012

On September 6, 2012, the Department of Justice (DOJ) announced it will join in a whistleblower lawsuit alleging false Medicare billings against Hospice of the Comforter Inc., By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Medicare 40

Medicare Medicare 40

HIT Consultant

OCTOBER 20, 2023

Curana has achieved this through a provider-led medical group, Medicare Advantage health plans, a Medicare Shared Savings Program (MSSP), and a newly formed ACO REACH organization. This expansion has provided over 750 healthcare providers with the opportunity to excel in value-based care delivery.

Nurses 59

Nurses Medicare Medicare Health Outcomes 59

The Health Law Firm

MAY 10, 2012

The first hospitals to be notified may receive their FICA refund checks as early as May 2012. FICA deductions are a percentage of the employee's wages that are withheld to help fund both the Social Security and the Medicare Programs. Indest III, J.D.,

Medicare 40

Medicare Medicare Hospitals 40

Healthcare IT Today

DECEMBER 17, 2023

Though this is a significant increase from 2012, numbers haven’t budged much since 2015. Pennsylvania-based WellSpan Health selected Arcadia data analytics to supports its Medicare Shared Savings Program. News In a blog post, ONC highlighted trends in patient access to electronic health information.

Hospitals 95

Hospitals Nurses Compliance Regulatory Compliance 95