HIT Consultant

NOVEMBER 8, 2021

The flexibility and cost savings that state-based marketplaces provide empowers state governments to drive real and lasting change in their healthcare markets. States, rather than the federal government, are in the best position to address issues unique to their markets and to their citizens.

Health Insurance 98

Health Insurance Medicaid Medicaid Governance 98

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Use this information as part of your auditing and monitoring efforts to prevent fraud, waste, and abuse of government funds.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare Compliance Blog

JANUARY 14, 2022

Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. The United States alleges that between 2013 and 2018 the shoe company sold diabetic shoe inserts that were represented to be custom made for an individual’s foot but were actually made using generic foot models.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

MedTrainer

NOVEMBER 27, 2023

Georgia Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Georgia Department of Public Health (DPH) plays a crucial role in safeguarding the health and well-being of Georgians. Keep reading for resources, tips, and regulations unique to healthcare compliance in Georgia.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Jane Sarashon

FEBRUARY 15, 2022

While his friend did not win his race, William Weld did win the governor’s post and Abner joined State government under Weld. He ended up working in Massachusetts State government for about 15 years. But in 2013, health equity wasn’t on anyone’s agenda. Still, Abner is cautiously optimistic.

Medicaid 94

Medicaid Medicaid Telemedicine Governance 94

The Health Law Firm

AUGUST 19, 2013

million to settle civil allegations under the False Claims Act, according to the Department of Justice (DOJ) on August 16, 2013. The nonprofit organization is accused of fraudulently billing Medicaid and other government programs for health services provided by some of its Texas clinics between 2003 and 2009, according to the DOJ.

Medicaid 40

Medicaid Medicaid Fraud Governance 40

MedTrainer

SEPTEMBER 8, 2023

The breach occurred in 2013 when four unencrypted laptops containing the electronic protected health information (ePHI) of over 4 million patients were stolen from an Advocate Health administrative building. Details of the settlement indicate the submission of false claims to Medicare, Medicaid, TRICARE, and FECA programs.

Compliance 52

Compliance HIPAA Medicaid Medicaid 52

HIPAA Journal

MAY 30, 2023

MCNA), which also does business as MCNA Dental – a provider of dental benefits and services for state Medicaid and Children’s Health Insurance Programs – has recently reported a major data breach to the Maine Attorney General that has affected 8,923,662 individuals. Managed Care of North America, Inc. Nascentia Health, Inc.

Health Insurance 105

Health Insurance Medicaid Medicaid Ransomware 105

McGuire Wood

OCTOBER 2, 2023

times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. This settlement includes more than $5.928 million in restitution, essentially a payment of 1.49

Fraud 52

Fraud Governance Compliance Medicare 52

Verisys

NOVEMBER 14, 2023

A healthcare facility’s accountability and overall reputation are dependent upon rigorous credentialing processes compliant with governing regulatory bodies, such as the National Committee for Quality Assurance. It is critical for hospitals and health systems to know that everyone on the staff is compliant and in good standing at all times.

Licensing 52

Licensing Medicaid Medicaid Governance 52

HIPAA Journal

FEBRUARY 23, 2022

Title III: Tax-related health provisions governing medical savings accounts. Title V: Revenue offsets governing tax deductions for employers. In 2013, the Omnibus Final Rule enacted provisions of the HITECH Act which made changes to the Security Rule to improve data security and further restrict access to ePHI.

HIPAA 100

HIPAA Fraud Health Insurance Medicaid 100

Healthcare Compliance Blog

MAY 9, 2022

million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.?Under

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Compliance 59

Healthcare IT Today

AUGUST 7, 2022

Cybersecurity company Surfshark found the number of government requests for user data increased 4x from 2013 to 2020 among Apple, Google, Facebook, and Microsoft. The four companies submitted user data to governments between 69% and 80% of the time. Facebook accounted for 40% of all requests, compared to just 7% for Apple.

Governance 98

Governance Telemedicine Medicaid Medicaid 98

Provider Trust

MAY 17, 2022

Which regulations govern vendor compliance? Finally, in order for the healthcare organization to get reimbursed by Medicare, Medicare Advantage and/or Medicaid, CHIPS or TriCare, the vendor must meet certain minimum requirements regarding safeguarding Protected Health Information (PHI). It also includes suppliers.

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Verisys

JANUARY 18, 2022

A healthcare facility’s accountability and overall reputation are dependent upon rigorous credentialing processes compliant with governing regulatory bodies, such as the National Committee for Quality Assurance. ISO 27001:2013 (information security). Utilization Review Accreditation Commission (URAC) accredited.

Licensing 52

Licensing Medicaid Medicaid Governance 52

The Health Law Firm

AUGUST 21, 2013

Board Certified by The Florida Bar in Health Law On August 19, 2013, Shands Healthcare agreed to pay $26 million to settle a lawsuit that stemmed from a whistleblower/qui tam claim. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Fraud 52

Fraud Governance Licensing FDA 52

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. Leider, J.D., The Health Law Firm.

Medicare 40

Medicare Medicare Fraud Medicaid 40

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Healthcare Law Blog

JANUARY 13, 2022

Let’s talk about fixing the huge American diabetes problem, providing better healthcare for Medicaid and dual eligible beneficiaries, and helping people beat cancer. Making Medicaid Better and Physicians More Accessible: Cityblock Health and ZocDoc. Did you know that on average one of every two babies today is born on Medicaid?

COVID-19 52

COVID-19 Medicaid Medicaid Doctors 52

HIPAA Journal

JULY 24, 2023

HHS was one of the first Departments to have an Office of Inspector General in 1976 due to billions of dollars being lost each year to Medicaid fraud. HHS OIG alleged that the organization had billed New York Medicaid for services furnished by the personal assistant. What is the HHS OIG Exclusions List?

Fraud 52

Fraud Medicare Medicare Medicaid 52

Healthcare Law Blog

MAY 31, 2022

The healthcare system in the United States is governed by an expansive network of state and federal laws, including the aforementioned HIPAA regulations. For example, services that are billed to Medicaid or Medicare must comply with regulations that may not apply to services that are paid for in cash. Healthcare Laws. 1, 2021). [2]

FDA 90

FDA HIPAA Medicare Medicare 90

HIPAA Journal

JANUARY 2, 2023

The following is a small selection of those we have reported on: In May 2013, Dianna Hereford was terminated from her position of staff nurse at the Norton Audubon Hospital for improperly disclosing the condition of a patient with Hepatitis C. How do HIPAA violations affect patients? What counts as a HIPAA violation by employees?

HIPAA 110

HIPAA Compliance Hospitals Medicare 110

C&M Health Law

MAY 11, 2022

Last week, the Centers for Medicare & Medicaid Services (CMS) released data —for the first time—reporting on mergers, acquisitions, consolidations, and changes of ownership of Medicare enrolled hospitals and nursing homes over the past six years.

Nursing Homes 52

Nursing Homes Nurses Medicaid Medicaid 52

Hall Render

JULY 22, 2022

Delaware Adds Centene Plan to Medicaid Managed Care Offerings. Key advocates reflect on Hawaii postpartum Medicaid coverage extension. Hospital System Says It’s Hurt by Lack of Medicaid Expansion. Medicaid expansion discussions return as Mississippi hospitals face financial struggles. Will health systems step up?

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

CMS.gov

NOVEMBER 2, 2018

Just another name for a government-run, single payer system. Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Just another name for a government-run, single payer system. Imagine funding the rest of government, from defense to education, at a level 30 percent less than today, or imagine a $2.5

Governance 55

Governance Medicare Medicare ACA 55

HIPAA Journal

MARCH 30, 2022

However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away. Furthermore, it could also be argued that neither Rule was effectively enforced until the Omnibus Final Rule was published in 2013. How HIPAA Addressed Health Insurance Reform.

HIPAA 131

HIPAA Fraud Health Insurance Health Care Reform 131

HIPAA Journal

JANUARY 9, 2023

The Health Insurance Portability and Accountability Act was signed into law in 1996 and while there have been some significant HIPAA updates over the last two decades, the last set of major HIPAA updates occurred in 2013 with the introduction of the HIPAA Omnibus Final Rule.

HIPAA 115

HIPAA COVID-19 COVID-19 Vaccine Compliance 115

Health Populi

DECEMBER 6, 2018

believe that the Federal government should ensure that their fellow Americans, a new Gallup Poll found. In contrast, in 2013 the Affordable Care Act was in implementation and consumer-adoption mode, accompanied by aggressive anti-“Obamacare” campaigns in mass media. Most people in the U.S. voters’ minds these days.

Governance 73

Governance Medical Billing Medicaid Medicaid 73

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. CMS is scheduled to release the audits later this year.

Medicare 107

Medicare Medicare Governance Overpayments 107