Hall Render

JUNE 8, 2023

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

Medicare 40

Medicare Medicare Hospitals Governance 40

Healthcare Compliance Blog

JANUARY 14, 2022

million to settle allegations that the company sold custom fabricated shoe inserts to Medicare recipients that did not meet Medicare standards. Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. A Florida based diabetic shoe company has agreed to pay over $5.5

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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 103

HIPAA Fraud Health Insurance Medicaid 103

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. 1395w-22(a) ). d)(2) ).

Medicare 40

Medicare Medicare Hospitals Medicaid 40

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

The Health Law Firm

MARCH 21, 2016

Board Certified by The Florida Bar in Health On February 3, 2016, the US District Court for the Eastern District of Michigan denied a motion to suppress all evidence of health care fraud seized by the government pursuant to a search warrant of Naseem Minhas’s home health care agency. in December 2013. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare Governance 40

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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. Juan Antonio Gonzalez, US Attorney for the Southern District of Florida, stated, “The fraudulent billing of Medicare will not be tolerated.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Compliance 59

The Health Law Firm

AUGUST 28, 2013

Bostwick Laboratories (Bostwick) will pay the government $503,668 to settle whistleblower allegations that the company made illegal payments to induce physicians to utilize Bostwick’s laboratory testing services, according to a press release from the Department of Justice (DOJ) on August 20, 2013.

Governance 40

Governance Medicare Medicare 40

HIPAA Journal

MAY 30, 2023

UFCW Local 2013 Health and Welfare Fund Catholic Managed Long Term Care, Inc Hicksville UFSD Nassau County Uniformed Fire Alarm Dispatchers Benevolent Association Centerlight Healthcare, Inc. The types of compromised information varied from individual to individual. Town Of Hempstead CareConnect Insurance Company Healthplex, Inc.

Health Insurance 103

Health Insurance Medicaid Medicaid Ransomware 103

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

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This wastes taxpayer money and interferes with your medical care. trillion in 2015.

Fraud 52

Fraud Medicare Medicare Compliance 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

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. billion recovered relating to Medicare fraud alone.

HIPAA 137

HIPAA Fraud Health Insurance Health Care Reform 137

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

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

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

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

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

American Medical Compliance

FEBRUARY 23, 2023

If a company is recognized as a covered entity, it must adhere to the HIPAA laws and regulations governing the privacy and security of health information. Health plans, healthcare providers, healthcare clearinghouses, and Medicare part D plans are all examples of covered entities. The government can fine providers up to $1.5

HIPAA 52

HIPAA Compliance Governance Health Insurance 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

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

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). 2] Black women have a maternal mortality rate 3.3 31, 2022). [2] 2] Emily E. Peterson, et.

Medicaid 52

Medicaid Medicaid ACA Public Health 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. Those trade-offs aside, Medicare Advantage is clearly proving attractive to consumers.

Medicare 107

Medicare Medicare Governance Overpayments 107

HIPAA Journal

JULY 24, 2023

This section relates to the “Exclusion of Certain Individuals and Entities from Participation in Medicare and State Health Care Programs”, which – although effective since the passage of the Medicare-Medicaid Anti-Fraud and Abuse Amendments in 1977 – had never been properly enforced due to a lack of resources.

Fraud 52

Fraud Medicare Medicare Medicaid 52

MedTrainer

JULY 20, 2020

RHCI), which operates a Medicare-certified Federally Qualified Health Center (FQHC) headquartered in Fort Pierre, South Dakota, successfully employed MedTrainer’s learning management system (LMS) to improve the tracking of staff training due dates and completions of mandated education courses.

Compliance 40

Compliance Medicare Medicare Governance 40

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. What are the consequences of accessing a patient chart without reason?

HIPAA 107

HIPAA Compliance Hospitals Medicare 107

Healthcare Law Blog

JANUARY 13, 2022

Kevin Conroy, CEO of Exact Sciences Corporation, asked today why, if deaths from cardiovascular disease dropped by 68% from 1969 to 2013, deaths from cancer only dropped by less than half of that, 31%, from 1991 to 2018. The Test of Cancer: Exact Sciences Corporation. The more you know…. What do you think the U.S. should be doing?

COVID-19 52

COVID-19 Medicaid Medicaid Doctors 52

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

CMS releases Medicare OPPS and ASC proposed rule. Long Beach Memorial avoids losing Medicare funding after serious patient care lapses. New York confirms 1st national polio case since 2013. US government suit against UPMC and star surgeon moves forward. UVM Health Network Redesigns Governance Structure.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Just another name for a government-run, single payer system. Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? Just another name for a government-run, single payer system. keya.joy-bush@….

Governance 55

Governance Medicare Medicare ACA 55

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 111

HIPAA COVID-19 COVID-19 Vaccine Compliance 111

Drug & Device Law

DECEMBER 29, 2023

2023) (federal government may unilaterally obtain dismissal of FCA claims, and calling the constitutionality of the FCA’s private enforcement mechanism into question) ( here ); Quishenberry v. 2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. Executive Health Resources, Inc. , 3d 239 (Cal.

FDA 105

FDA US Department of Health and Human Services COVID-19 COVID-19 Vaccine 105

Drug & Device Law

JANUARY 30, 2023

472 (2013), implied preemption decisions, cited only by the dissent in Wyeth v. 483 (2013), concurrence regarding preemption concerning insurance policies of federal employees – supports preemption when the “ordinary meaning” of a federal statute “effectively repeals contrary state law” by virtue of a “direct conflict” Oneok, Inc.

FDA 72

FDA Fraud Governance Medicare 72