Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. Deceiving MassHealth: The Disturbing Truth Behind Dental Services From 2014 to 2018, a shocking scheme unfolded within the realm of dental services.

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Fraud Medicaid Medicaid Governance 52

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

The Health Law Firm

JANUARY 13, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) is proposing to exclude providers from Medicare if the government determines a pattern of abusive prescribing practices of Medicare Part D drugs. CMS described these efforts on January 6, 2014, in a proposed rule. Smith, R.R.T.,

Medicare 40

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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 that, he spent 17 years as CEO of HealthPartners, a cooperatively governed health plan and care system in Minnesota. Isaiah Nathaniel. CIO, Delaware Valley Community Health. Philadelphia.

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COVID-19 Department of Veterans Affairs COVID-19 Vaccine Nurses 116

The Health Law Firm

APRIL 21, 2014

Board Certified by The Florida Bar in Health Law For years, the Centers for Medicare and Medicaid Services (CMS) kept private its records on Medicare reimbursement payments made to physicians, however, on April 9, 2014, that all changed. Indest III, J.D.,

Medicare 40

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Med-Net Compliance

AUGUST 16, 2022

The co-defendants allegedly engaged in these acts in whole or in part, to avoid government sanctions, including a denial of payments for new admissions, additional monitoring, the imposition of civil monetary penalties, and other potential penalties.

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Health Populi

AUGUST 24, 2018

The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014 , published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. We need all hands on deck: in the kitchen, grocery stores and retailers, schools, doctors’ offices, and government agencies.

Public Health 72

Public Health Doctors Medicaid Medicaid 72

Verisys

MARCH 23, 2023

This is the largest amount recovered under the False Claims Act since 2014. Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor. The Most Common False Claims The FCA primarily combats healthcare fraud and abuse associated with Medicare and Medicaid.

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Healthcare IT Today

JANUARY 4, 2023

Healthcare providers maintain different systems than payers, as do government entities like Medicare and Medicaid. billion in 2014. Data, especially in an increasingly personalized healthcare system, is inevitably siloed. He was recently named to Business Insiders 30 Under 40 Changing the Healthcare Industry in 2022.

US Department of Health and Human Services 75

US Department of Health and Human Services Doctors COVID-19 Health Outcomes 75

Hall Render

FEBRUARY 27, 2023

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, as whistleblowers filed 652 qui tam suits in 2022 with recovery totaling $1.9 The government initiated 296 FCA cases on its own last year without input of a relator, which is the highest volume of DOJ initiated cases since the 1986 FCA amendments.

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Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The term “knowingly” has the meaning set forth in 31 U.S.C.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

MedTrainer

NOVEMBER 20, 2023

Florida Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Florida Department of Health (DOH) plays a crucial role in promoting and safeguarding the wellbeing of Floridians. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

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Compliance Licensing Regulatory Compliance Medicaid 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Enrollee Participation in Dual Eligible Special Needs Plan (“D-SNP”) Governance (§ 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 Certainly, implementing prospective programs takes time, operating discipline, and analytical prowess, but it can yield improved outcomes as well as reduce downside risk from government audits. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

HIT Consultant

FEBRUARY 20, 2024

They alleged that these procedures were performed unnecessarily, driven by a corporate strategy to maximize profits by overtreating children from lower-income families enrolled in Medicaid. Zion’s demise was attributed to “brain damage caused by a lack of oxygen,” as per the lawsuit.

Health Insurance 52

Health Insurance Medicaid Medicaid Governance 52

Healthcare Law Blog

JANUARY 11, 2023

It’s also enough to cause the chief executive officers of these three plans to discuss the possibility of industry litigation against the federal government – which threat was effective in an earlier round of health plans versus CMS and delayed audits, enforcement actions and repayments under the Medicare Advantage risk adjustment program for years.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Redox

DECEMBER 4, 2020

Immunization information systems (IIS) have received special focus as part of government health initiatives (Meaningful Use 1 and 2), so every state has one or more: More accurate information about the number of distinct IIS in the US: [link] — Lisa Bari (she/her/hers) (@lisabari) November 17, 2020. The government thought the same.

Public Health 52

Public Health Governance Doctors Medicare 52

Kaiser Health News

JANUARY 6, 2022

South Dakota voters will decide in November whether the state should become the 39th to expand Medicaid under the Affordable Care Act, a move that would provide coverage to 42,000 low-income residents. Kristi Noem, a Republican, strongly opposes Medicaid expansion, even though the federal government picks up most of the cost.

Medicaid 126

Medicaid Medicaid ACA Governance 126

Bill of Health

MAY 22, 2023

The selections feature topics ranging from an analysis of government and industry investments for recently approved drugs, to a discussion of court decisions on mifepristone, and an examination of the added therapeutic benefit associated with the top-selling brand-name drugs in Medicare. JAMA Netw Open. 2023 Apr 3;6(4):e238835.

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Pharmaceutical Industry Medicare Medicare Medicaid 162

Health Law Advisor

AUGUST 10, 2023

5] But that Interstate Commerce Clause needs to be viewed also in balance with the 10th Amendment of the Constitution, which reserves to the states any powers not delegated to the federal government. 12] FDA Draft Guidance, “Framework for Regulatory Oversight of Laboratory Developed Tests (LDTs)” (October 2014), available at [link]. [13]

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FDA Licensing Hospitals Medicaid 98

Hall Render

SEPTEMBER 22, 2023

in repairs Sutter Health faces possible $519M payout in alleged double billing case COLORADO Denver Health sued by sons after father’s jail death How a Kaiser Permanente worker strike could affect Colorado patients Kaiser names regional president Medical Office Building in Littleton Sells for $6.1M

COVID-19 40

COVID-19 Nursing Homes COVID-19 Vaccine Nurses 40

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Enrollee Participation in Plan Governance (§ 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Kaiser Health News

JUNE 13, 2024

Medicare and Medicaid similarly can’t deny coverage based on health background, though age and income-based eligibility requirements mean many Americans don’t qualify for that coverage. .” Depending on the definition, the number could be smaller, but it also could be even greater and is likely to have increased since 2014.

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ACA Health Insurance Medicaid Medicaid 110