AIHC

JANUARY 28, 2022

For more information on filing compliance cost reports, attend the Medicare Cost Report Camp in March 2022 presented by KraftCPAs and sponsored by the American Institute of Healthcare Compliance. This is calculated based on the hospital’s relative share of uncompensated care nationally. This is known as the hospital “market basket.”

Medicare 52

Medicare Medicare Hospitals Payment Systems 52

Bill of Health

NOVEMBER 17, 2022

Fulfillment of Postmarket Commitments and Requirements for New Drugs Approved by the FDA, 2013-2016. Medicare’s National Coverage Determination for Aducanumab – A One-Off or a Pragmatic Path Forward? Brown BL, Mitra-Majumdar M, Darrow JJ, Moneer O, Pham C, Avorn J, Kesselheim AS. JAMA Intern Med. 2022 Oct 3:e224226.

FDA 190

FDA World Health Medicaid Medicaid 190

The Health Law Firm

FEBRUARY 1, 2016

Board Certified by The Florida Bar in Health Law On Friday, a Miami pharmacy owner charged in a Medicare fraud scheme, surrendered to US authorities after hiding in Cuba for over two years. Sandy De La Fe, was charged in 2013 with unlawfully pocketing $2.8 Indest III, J.D., False Claims for Prescription Drugs.

Fraud 40

Fraud Medicare Medicare Doctors 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

HIT Consultant

OCTOBER 27, 2023

in 2013 to 4.6% Data from MSSP, Medicare’s largest ACO program serving 11 million beneficiaries, consistently indicates that primary care-focused ACOs (more than 75% of clinicians are primary care) provide higher-value services on a population basis, producing more than twice the savings as hospital-based ACOs.

COVID-19 91

COVID-19 Medicare Medicare Hospitals 91

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 52

Healthcare Compliance Blog

MAY 19, 2022

million to settle allegations that it violated the False Claims Act by submitting false claims to Medicare. The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, the hospital submitted claims to Medicare for Intensive Cardiac Rehabilitation (ICR) services provided to Medicare beneficiaries.?Before

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 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

JANUARY 23, 2013

It’s no surprise to anyone that Medicare is cracking down on hospices around the country. According to a report by the Office of Inspector General (OIG), eighty-two percent (82%) of hospices’ claims did not meet Medicare coverage requirements. That is why Medicare is investigating the industry as a whole.

Medicare 40

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 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

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

Healthcare IT Today

APRIL 28, 2023

billion through Arcadia’s Medicare Shared Savings Program (MSSP) service. Since formation in 2013 and as of December 31, 2022, VCP has deployed over $9.7 The past year included several important milestones for Arcadia, including: Inclusion on Inc. billion and grown to over $6.6 billion of assets under management.

Medicare 110

Medicare Medicare Health Outcomes Hospitals 110

The Health Law Firm

AUGUST 29, 2013

Board Certified by The Florida Bar in Health Law A therapy staffing company owner and a patient recruiter pleaded guilty on August 21, 2013, to one count each of conspiracy to commit health care fraud in connection with a $7 million Medicare fraud scheme. Indest III, J.D., Click here to read the press release from the DOJ.

Fraud 40

Fraud Medicare Medicare Nurses 40

The Health Law Firm

OCTOBER 9, 2013

Board Certified by The Florida Bar in Health Law The University of Miami Hospital allegedly owes Medicare $3.7 The report was released on October 8, 2013, by the US Department of Health and Human Services (HHS) Office of Inspector General (OIG). Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Overpayments 40

HIT Consultant

NOVEMBER 3, 2022

lets providers track their individual performance and annual trends to identify opportunities to improve measures for savings and expenditures, care quality, and utilization, using the latest data from the Medicare Shared Savings Program (MSSP) ACOs for performance years 2013 through 2021. ACO Compare 4.0

Medicare 52

Medicare Medicare 52

The Health Law Firm

SEPTEMBER 3, 2013

million to settle claims it overbilled Medicare and Medicaid for cancer clinical trial services that were not permitted by the Medicare and Medicaid rules. This announcement from the Department of Justice (DOJ) was released on August 28, 2013. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

SEPTEMBER 24, 2013

Leider with The Health Law Firm will be giving a presentation on Thursday, September 26, 2013, to the members of the Medical Office Resources of Florida (MOROF) and attending health care providers. This presentation is called, “Medicare and Medicaid Audits: Ready or Not, Here They Come.” Brown and Lance O.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

JANUARY 28, 2013

A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Fraud 40

Med-Net Compliance

OCTOBER 19, 2022

The settlement resolves allegations that between 2013 and 2020, the company paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients. The corporate officers were previously the CEO and COO of the company.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Medicaid 59

Medval Compliance Blog

MARCH 10, 2022

by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047). 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Healthcare IT Today

FEBRUARY 27, 2024

HealthBeacon was founded in 2013 in Dublin, Ireland. The product is patent protected, FDA cleared, and FSA, HSA, Medicare, and Medicaid eligible. Postal Service’s approved mail-back program. HealthBeacon also provides a digital risk management platform for prescribing restricted medication to oncology patients.

FDA 111

FDA Licensing Medicaid Medicaid 111

HIT Consultant

FEBRUARY 16, 2023

In 2013, My mother would have met the screening criteria to get a CT but she did not get scanned and in September of that year, her stage 4 lung cancer was identified and she died shortly after. This is an issue that primary care is struggling with, compounded by the lack of time to properly see and assess patients during the day.

Doctors 98

Doctors Medicare Medicare Compliance 98

The Health Law Firm

JULY 26, 2013

Board Certified by The Florida Bar in Health Law On July 23, 2013, the House Energy and Commerce Health Subcommittee approved a proposal to repeal Medicare’s sustainable growth rate (SGR) physician payment formula in lieu of a system that rewards doctors for high quality care. Leider, J.D., The Health Law Firm and George F.

Medicare 40

Medicare Medicare Doctors 40

HIT Consultant

AUGUST 17, 2023

Needs more training for healthcare workers to manage the technology and remote consultations The Department of Health and Human Services has made permanent changes to Medicare telehealth policies influenced by the pandemic. That goes for maternity care, too. Since the company’s inception, they have raised over $37M.

Medicaid 96

Medicaid Medicaid Telemedicine Doctors 96

The Health Law Firm

MAY 10, 2013

A Miami patient recruiter will spend the next 37 months in prison for his part in a $20 million Medicare fraud scheme, according to the Department of Justice (DOJ). Manuel Lozano was sentenced on May 6, 2013, in the Southern District of Florida. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare 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

HIT Consultant

FEBRUARY 16, 2023

In 2013, My mother would have met the screening criteria to get a CT but she did not get scanned and in September of that year, her stage 4 lung cancer was identified and she died shortly after. This is an issue that primary care is struggling with, compounded by the lack of time to properly see and assess patients during the day.

Doctors 94

Doctors Medicare Medicare Compliance 94

The Health Law Firm

MARCH 21, 2016

in December 2013. Indest III, J.D., 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.

Fraud 40

Fraud Medicare Medicare Governance 40

HIPAA Journal

JUNE 9, 2023

In 2013, David Dubin was examining a patient when he was informed by his father that the patient’s Medicaid benefits had been exhausted and cut the evaluation short. The Supreme Court decision related to the latter. William and David Dubin are father and son psychologists who ran a mental health testing company called Psychological ARTs.

Fraud 107

Fraud Medicaid Medicaid Doctors 107

Electronic Health Reporter

JULY 23, 2018

The successor to the 2013 BPCI program, BPCI Advanced is CMS’ most significant episodic payment reform proposal to date, indicating the government’s […]. The Bundled Payments for Care Improvement (BPCI) Advanced initiative is a new advanced alternative payment model (APM) that will go live October 1, 2018.

Medicare 79

Medicare Medicare 79

Innovaare Compliance

FEBRUARY 7, 2022

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to whom the company delegates those obligations.

Medicare 52

Medicare Medicare Compliance Medicaid 52

HIPAA Journal

OCTOBER 21, 2022

In 2013, HHS confirmed that paper-to-paper, non-digital faxes are not covered transactions). Advocates of NPIs are hoping that the introduction of Medicare Beneficiary Numbers (which went into effect in January 2020) will demonstrate to Congress that the benefits of NPIs far outweigh the costs. #4.

HIPAA 107

HIPAA Compliance Medicare Medicare 107

Healthcare IT News - Telehealth

OCTOBER 19, 2020

In the suit, the EHR giant argues that it has used the CarePort trademark since 2013 and that in 2018 the telemedicine company changed its name from ER at Home to CarePortMD. Earlier this summer, CarePort launched a tool to help hospitals comply with the Centers for Medicare and Medicaid Services' interoperability final rules.

Telemedicine 125

Telemedicine Medicaid Medicaid Hospitals 125

McGuire Wood

OCTOBER 2, 2023

According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. The disclosure noted that claims for certain referred services were submitted for payment to Medicare, thus invoking the reach of the implicated federal laws. CMS Voluntary Self-Disclosure.

Fraud 52

Fraud Governance Compliance Medicare 52

HIPAA Journal

JULY 4, 2024

The above HIPAA rules and regulations are mostly administered and enforced by HHS’ Office for Civil Rights (Parts 160 and 164) and HHS’ Centers for Medicare and Medicaid (Part 162). Fortunately, the changes since 2013 have been limited in scale (i.e., the NIC amendment to the Privacy Rule) or regular in nature (i.e.,

HIPAA 58

HIPAA Compliance Fraud Medicare 58

HIT Consultant

APRIL 14, 2023

Presbyterian Health Services, for example, has longstanding experience with a provider-based health plan, and UnityPoint’s CEO noted in an interview with Modern Healthcare that this experience could help it bolster its Medicare Shared Savings Program and accountable care organization offerings.

COVID-19 52

COVID-19 Hospitals Medicare Medicare 52