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

Healthcare Compliance Blog

MARCH 16, 2022

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

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

Medicare Medicare Medicaid Medicaid 40

Healthcare IT News - Telehealth

DECEMBER 17, 2021

According to the indictment , starting in May 2014 the defendants and their co-conspirators allegedly used telehealth to generate prescriptions for compounded medications and durable medical equipment, regardless of medical necessity. The agency said that patient information had been provided by marketing companies. THE LARGER TREND.

Fraud 138

Fraud Telemedicine Nurses Licensing 138

Healthcare Compliance Blog

FEBRUARY 15, 2022

This is the second largest annual total in False Claims Act history, and the largest since 2014. Congress strengthened the False Claims Act by increasing incentives for whistleblowers to file lawsuits alleging false claims on behalf of the government. More than $5.6 Total recovery now totals more than $70 billion.

Fraud 59

Fraud Governance Compliance Medicare 59

The Health Law Firm

AUGUST 22, 2016

Board Certified by The Florida Bar in Health Law On July 11, 2016, a federal appeals court stated that a bankruptcy judge did not have the authority to block government health officials from cutting off Medicare and Medicaid payments to a Florida nursing home that was alleged to have violated patient-care regulations. Indest III, J.D.,

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Medicaid 40

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.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Health Law Advisor

FEBRUARY 3, 2022

billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 According to DOJ’s statistics, the government paid out $238 million to relators in FY 2021, the lowest number since FY 2008. With collections amounting to $5.6 billion received in FY 2020.

Fraud 52

Fraud COVID-19 Governance Medicare 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”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Populi

JUNE 18, 2021

workers with private insurance more likely report poor access to health care, greater costs of care, and lower satisfaction with care versus people covered by public health insurance plans — whether Medicaid, Medicare, VHA or military coverage. One-half of U.S. Health Populi’s Hot Points: U.S. households.

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ACA Health Insurance Medicaid Medicaid 139

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.

Fraud 59

Fraud Nurses Medicaid Medicaid 59

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 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

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). ” United States ex rel. Healthfirst, Inc. , 3d 370, 389 (S.D.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

HIT Consultant

JULY 16, 2024

Because Medicaid is jointly funded by state and federal governments, there’s no standard approach to prioritizing or implementing technology reimbursement. About Anish Sebastian Anish Sebastian co-founded Babyscripts in 2014 with the vision that internet-enabled medical devices and big data would transform the delivery of pregnancy care.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

Healthcare Law Blog

JANUARY 11, 2023

Morgan Healthcare Conference, you would know that all three are waiting to see what the upcoming final rule on Medicare Advantage risk adjustment data validation (known as RADV) audits will mean for the industry when it drops in February. (Trying really hard not to start off with a “three health plans walk into a bar” joke…). to perhaps a 2.3

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Provider Trust

JULY 26, 2022

District Attorney alleges that Pickering was hired in 2019 as a licensed physician’s assistant at a family practice in Norcross, Georgia but had not been a licensed physician’s assistant in Georgia, or any state, since March 2014. According to the U.S. The Importance of Conducting License Verification and Monitoring.

Licensing 52

Licensing Fraud Compliance Nurses 52

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.

COVID-19 98

COVID-19 Department of Veterans Affairs COVID-19 Vaccine Nurses 98

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, Fragmentation, and the Power for Good. Data, especially in an increasingly personalized healthcare system, is inevitably siloed.

US Department of Health and Human Services 66

US Department of Health and Human Services Doctors COVID-19 Health Outcomes 66

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. Cliff ERS, Kesselheim AS, Rome BN, Feldman WB.

Pharmaceutical Industry 163

Pharmaceutical Industry Medicare Medicare Medicaid 163

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.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

Health Populi

OCTOBER 24, 2022

I had asked some years ago, “what is a pharmacy” anymore, when CVS Pharmacy dropped tobacco from its SKUs and aisles in February 2014, rebranding as CVS Health; and, when Amazon purchased PillPack in June 2018. ” Dr. Cosgrove based that sobering forecast due to changes in the U.S.

COVID-19 54

COVID-19 Prescription Drug Pricing Health Insurance Health Care Reform 54

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

Health Populi

OCTOBER 8, 2018

At the time of the signing of HITECH, Medicare and healthcare costs were seen as a key driver of America’s long-term deficit spending at this low point in the national economy. Some historical perspective is useful for context. Beyond the local economic effects, think about the larger region or State.

Hospitals 61

Hospitals Health Insurance Health Outcomes Telemedicine 61

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]

FDA 98

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

Kaiser Health News

DECEMBER 10, 2021

None of the eight states with the most rural hospital closures since 2014, when Medicaid expansion was first implemented through the Affordable Care Act, had chosen to expand the insurance program by the start of 2021. In several of those states, including Georgia, Republican-led governments have said such a step would be too costly.

Hospitals 141

Hospitals Medicaid Medicaid COVID-19 141

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