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 Medicaid Medicaid 40

VW Health Care Law Blog

NOVEMBER 9, 2016

The Centers for Medicare and Medicaid Services finalized a rule in March 2014 that required healthcare providers prescribing medication, where the prescription is paid for by a Medicare Part D plan, to enroll in Medicare as a prescriber.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

JULY 14, 2023

FCA Allegations The allegations contends that NextGen falsely obtained certification for its software in connection with the 2014 Edition certification criteria published by HHS’s Office of the National Coordinator. The whistleblowers in this case will receive $5.58M.

Governance 94

Governance Medicaid Medicaid Medicare 94

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

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

The Health Law Firm

JANUARY 29, 2015

This hypothetical situation begs the question: Why would physicians agree to treat Medicaid patients? Treating Medicaid patients has never been a money maker for physicians. However, for the past two years, Medicaid programs have been required to reimburse primary care providers at Medicare levels, which is typically higher.

Medicaid 40

Medicaid Medicaid ACA Medicare 40

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. Medicare and Medicaid data demonstrated that he was identified as an outlier and the highest biller for this procedure in New York State.

Fraud 59

Fraud Doctors Medicare Medicare 59

The Health Law Firm

DECEMBER 11, 2014

Board Certified by The Florida Bar in Health Law Stop me if you've heard this one before: the Centers for Medicare and Medicaid Services (CMS) recently increased Medicare's authority over physicians and other health care providers. On December 3, 2014, CMS released these new anti-fraud measures. Indest III, J.D.,

Medicare 40

Medicare Medicare Fraud Medicaid 40

The Health Law Firm

JUNE 4, 2014

The Health Law Firm On June 1, 2015, doctors and other health care providers will be under tighter restrictions when prescribing to Medicare Part D patients. Most health care providers are already enrolled in Medicare. Leider, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

JUNE 6, 2014

Under a rule finalized by the Centers for Medicare and Medicaid Services (CMS) on May 19, 2014, doctors and other health care professionals will be required to enroll in the Medicare program, or have a valid opt-out affidavit on file, for prescriptions to be covered under Part D. By Lance O. Leider, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

Medicare 52

Medicare Medicare Fraud Medicaid 52

HIT Consultant

MARCH 2, 2023

Centers for Medicare and Medicaid Services (CMS) to continue its work supporting Healthcare.gov. – In 2014, Accenture Federal Services was awarded a prime contract to take over management of the Federally-Facilitated Exchange (FFE).

Health Insurance 52

Health Insurance Medicaid Medicaid Medicare 52

Healthcare IT Today

APRIL 21, 2023

Funding Will Grow Medication Adherence Services for Medicaid and Other Under-Resourced Populations Scene Health , the leading medication engagement company, has closed an oversubscribed $17.7 This financing brings the total investment in Scene to over $25 million since its founding in 2014.

Medicaid 64

Medicaid Medicaid Medicare Medicare 64

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”).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

HIT Consultant

APRIL 20, 2022

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. Tom Zaubler, MD, Chief Medical Officer of NeuroFlow.

Medicare 98

Medicare Medicare Telemedicine Medicaid 98

The Health Law Firm

MARCH 6, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) continues to stop fraudulent repayment claims before they happen. The six-month moratorium began January 31, 2014. Indest III, J.D., Click here to read the press release from CMS.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

Med-Net Compliance

AUGUST 16, 2022

In addition, from in and around June 2014 to in and around June 2021, the CEO conspired with two regional-level employees and others to commit healthcare fraud. Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment.

Fraud 59

Fraud Nurses Medicaid Medicaid 59

HIPAA Journal

JULY 3, 2024

Indeed, many of the classification systems that would eventually be adopted as the HIPAA transactions and code sets rules were already mandated for use in some federal and state healthcare programs – including Medicare and Medicaid. Health Plan Premium Payments. Coordination of Benefits.

HIPAA 58

HIPAA Medicaid Medicaid Compliance 58

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

HIPAA Journal

SEPTEMBER 11, 2023

In 2016, a media outlet reported that members of the health plan were able to access the protected health information (PHI) of other members via the online member portal over a 2-day period in 2014 due to a manual processing error. OCR informed L.A. Care Health Plan it had initiated a compliance review and in February 2016, L.A. The post L.A.

HIPAA 79

HIPAA Compliance Medicaid Medicaid 79

The Health Law Firm

APRIL 4, 2014

The Health Law Firm On February 28, 2014, the Centers for Medicare and Medicaid Services (CMS) issued its revised emergency preparedness checklist for health care facility planning. By Lenis L. Archer, J.D.,

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Verisys

MARCH 23, 2023

This is the largest amount recovered under the False Claims Act since 2014. The Most Common False Claims The FCA primarily combats healthcare fraud and abuse associated with Medicare and Medicaid. Violation of this law requires health services to be payable by Medicare or Medicaid.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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). Figure 1 – 0938-AT85 (Click image to go to website).

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Health Care Law Brief

JUNE 26, 2022

Under the traditional, or fee-for-service (FFS), Medicare program, CMS directly pays providers a predetermined rate for the items and services furnished to patients under Medicare Parts A and B. 29844, 29921 (May 23, 2014). CMS’s Payments to MA Plans. at § 1395w-23(b)(4)(D).

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

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

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

CMS.gov

NOVEMBER 15, 2018

Administrator, Centers for Medicare & Medicaid Services. Approximately 60 million people live in rural areas – including millions of Medicare and Medicaid beneficiaries. Also, Medicare will now pay separately for Remote Evaluation of Recorded Video and/or Images Submitted by the Patient. Jeremy.Booth@c….

Medicare 50

Medicare Medicare Payment Systems Medicaid 50

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

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. It is not until after this six-month investigation period that the 60 days to report starts to run.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

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

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 public has until 5 p.m.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

CMS.gov

MARCH 6, 2013

By: Christine Stahlecker, Director, Administrative Simplification Group, Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services. Visit our ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014 , deadline.

ACA 30

ACA HIPAA Medicaid Medicaid 30

HIT Consultant

FEBRUARY 8, 2023

Kishore Pendyala, CEO of KP-Tech Services The Fast Healthcare Interoperability Resources (FHIR) standard was introduced by HL7 in 2014 as a significant replacement for the HL7 V2 and V3 standards. An open standard called FHIR, which was initially drafted in 2011, makes it easier than ever for legacy systems and new apps to exchange data.

HIPAA 52

HIPAA Medicaid Medicaid Medicare 52

Healthcare Law Blog

MARCH 25, 2022

To effectuate the program, HHS created a three-step risk-adjustment methodology: First, for each individual enrolled in an insurer’s plan, an actuarial risk score is computed using demographic and diagnostic data to determine the predicted cost of insuring that enrollee ( see 2014 Final Rule, 78 Fed. at 15,432 ); and.

ACA 52

ACA US Department of Health and Human Services Health Insurance Medicaid 52

CMS.gov

MARCH 7, 2013

Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. By Patrick Conway, MD, MSc. The next step on the path of meaningful adoption of health information technology (HIT) for providers—will launch later this year for hospitals and next year for eligible professionals.

Medicaid 32

Medicaid Medicaid Medicare Medicare 32

Hall Render

FEBRUARY 27, 2023

Health Care Fraud Actions Medicaid. The Medicaid program was a target in 2022. DOJ recovered $260 million from a pharmaceutical company for its underpayment of rebates to the Medicaid program by improperly designating one product as a new drug. It also recovered $70.7 A pharmaceutical company paid $843.8

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40