The Health Law Firm

FEBRUARY 19, 2016

Board Certified by The Florida Bar in Health Law On February 12, 2016, a Florida ophthalmologist accused of bribing his friend, US Sen. Robert Menendez, said that separate allegations against him for Medicare fraud should be dismissed. By George F. Indest III, J.D.,

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The Health Law Firm

DECEMBER 5, 2017

Board Certified by The Florida Bar in Health Law On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 US Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D.,

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The Health Law Firm

AUGUST 11, 2016

Board Certified by The Florida Bar in Health Law On August 8, 2016, a Pennsylvania hospital accused of overbilling Medicare agreed to settle civil claims with the federal government for $325,000, the US Attorney’s office in Philadelphia announced. By George F. Indest III, J.D.,

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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.

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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) ).

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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. By George F. Indest III, J.D.,

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Healthcare IT Today

OCTOBER 10, 2022

Changes are afoot in the way insurers and governments pay for the drugs and treatments patients need-and a big part of that change includes a move towards value-based contracting, with prices set based on the outcome of treatments. The following is a guest article by Girisha Fernando, Founder and CEO at Lyfegen.

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The Health Law Firm

JULY 12, 2016

Board Certified by The Florida Bar in Health Law On June 24, 2016, Prime Healthcare Services, Inc. Prime), a California-based company whose mission was stated to be turning around struggling hospitals, is alleged to have run a systematic scheme to defraud the federal government. Strategies That Violated Medicare’s Trust.

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Healthcare Compliance Blog

APRIL 12, 2022

By pleading guilty, the business owner admitted that she willfully failed to deposit the Federal Insurance Contributions Act and Medicare (FICA) taxes and income taxes that were withheld from her employees’ wages. However, instead of forwarding those taxes to the government, she kept them for her business.

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Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. US Attorney Ashley C.

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Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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The Health Law Firm

DECEMBER 20, 2016

Board Certified by The Florida Bar in Health Law On December 14, 2016, owners of an East Texas clinical laboratory who overcharged Medicare for falsified driving mileage bills have agreed to pay the US government $3.75 By George F. Indest III, J.D., million to settle a whistle blower's False Claims Act (FCA) lawsuit.

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Health Law RX

NOVEMBER 10, 2022

The United States alleged that, between August 1, 2016 and June 30, 2017, Sutter Health fraudulently billed and received reimbursement from government health programs for lab tests that Sutter Health did not itself perform. Some patients treated were allegedly able to walk without assistance and were ineligible for homebound therapy.

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Governance Medicare Medicare Medicaid 52

Healthcare Law Today

JANUARY 2, 2023

In the 2016 Final Rule , CMS agreed “the 60-day time period begins when either the reasonable diligence is completed or on the day the person received credible information of a potential overpayment if the person failed to conduct reasonable diligence and the person in fact received an overpayment. § 401.305(a)(2).

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Overpayments Overpayment ACA Medicare 52

Compliancy Group

JUNE 28, 2024

That 2016 law was established to accelerate the discovery, development, and delivery of 21st century cures, by streamlining drug and device approval processes, and bringing treatments to market faster. These disincentives withhold money that a provider might have earned under certain federal government incentive or “bonus” programs.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Comments Comments.

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HIPAA Hospitals Medicare Medicare 60

Health Blawg

JANUARY 9, 2018

The apoplectic response of the regulated community and commentariat to the off-message message conveyed via email moved CMS to issue an official statement more in line with the joint communiqué of December 2016. Fear not, gentle reader. most hospitals). Comments […] article was originally published on HealthBlawg and. Fear not, gentle reader.

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HIPAA Hospitals Medicare Medicare 60

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

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HIT Consultant

JUNE 7, 2023

In 2016, the Golden State began its Whole-Person Care (WPC) pilots at the county level integrating physical health, behavioral health, and social services for complex needs Medicaid enrollees. billion (about $42 per person in the US) per year after paying for the cost of food with most savings occurring within Medicare and Medicaid.

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Healthcare IT Today

JUNE 29, 2023

Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage. Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008.

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Compliance Medicare Medicare Medical Billing 52

MedTrainer

SEPTEMBER 8, 2023

Advocate Health Care HIPAA Breach (2016) In August 2016, Advocate Health Care Network —one of the largest healthcare systems in Illinois—agreed to settle potential violations of Privacy and Security Rules for $5.55 Details of the settlement indicate the submission of false claims to Medicare, Medicaid, TRICARE, and FECA programs.

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Compliance HIPAA Medicaid Medicaid 52

Hall Render

JANUARY 21, 2022

The Hospital’s Joint Conference Committee (“JCC”), which was vested with final authority to issue a non-appealable decision, held its final hearing on September 22, 2016. The decision was considered final and was subsequently communicated to the plaintiff days later on September 27, 2016. written letter) on September 27, 2016.

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Hospitals Medicare Medicare Governance 40

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

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Overpayments Overpayment Medicare Medicare 52

Florida Health Care Law Firm

DECEMBER 2, 2021

As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”. But, disclosures must be made in good faith and not done in an attempt to circumvent an ongoing investigation.

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Healthcare Law Blog

NOVEMBER 21, 2022

Pharmaceutical manufacturers are challenging the breadth of the Federal Anti-Kickback Statute (“AKS”) in federal court, arguing that the government is harming the very vulnerable patients it aims to serve by prohibiting cost-sharing subsidies for life-saving oncology drugs. and $500.39. [4].

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Medicare Medicare Governance Medicaid 52

HIT Consultant

OCTOBER 4, 2021

The Centers for Medicare and Medicaid Services (CMS) strive for innovations in healthcare technologies that drive down costs and improve the patient experience. One big step forward is the 21 st Century Cures Act passed in 2016, putting patients in charge of their own health records.

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Kaiser Health News

JULY 11, 2023

But a recent state report from Colorado found that, even after accounting for low Medicaid and Medicare rates, hospitals get enough from private health insurance plans to provide more charity care and community benefits than they do currently and still turn a profit.

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Healthcare Law Blog

MARCH 20, 2023

In light of the behavioral health shortage, and now that these crucial digital health resources have been established, the most looming priority for private and government payors is to address workforce limitations, which directly lead to accessibility limitations for mental health patients. November 2022. [2] 21, 2023). [5] 5] Bellon, J.,

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Medicaid Medicaid Licensing ACA 52

YouCompli

AUGUST 16, 2023

For example, let’s say there was an audit that identified a billing error which resulted in a six-figure repayment to Medicare. For example, let’s assume you have been made aware that the organization inadvertently billed Medicare for a particular procedure in error (e.g., the wrong procedure code was billed).

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Compliance HIPAA Medicare Medicare 52

Health Law RX

JULY 18, 2023

Information Blocking Background In 2016, the 21st Century Cures Act (Cures Act) made sharing electronic health information (EHI) the new normal in healthcare, with the twin goals of encouraging and incentivizing the free flow of patient information among stakeholders and driving efficiencies in healthcare.

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Fraud Compliance Medicaid Medicaid 52

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Innocent” Property Can’t Be Seized. To read more on the U.S.

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Fraud Medicare Medicare Governance 40

Healthcare Compliance Blog

APRIL 19, 2022

A Mississippi man conspired with other individuals to provide fraudulent statements to Medicare for reimbursements of claims for patient treatment and prescriptions. The events took place between January 2016 through March 11, 2019, during which time the man claimed to be a licensed physician in the state of Mississippi.

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Licensing Medicare Medicare Governance 59

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Actuarial Soundness.

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Health Law Advisor

APRIL 13, 2023

A point of departure is the guidance in the updated FAQs governing naloxone. Worth noting is that the day after OIG’s publication of the updated FAQs, Robert DeConti, Chief Counsel of the Inspector General, speaking at the AHLA’s Institute on Medicare and Medicaid Payment Issues, offered a few related thoughts.

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Health Law Advisor

AUGUST 10, 2023

2] Implementing the 21st Century Cures Act from 2016, regulated CDS software includes that intended to “analyze” “medical information about a patient or other medical information” “for the purpose of supporting or providing recommendations to a healthcare professional about prevention, diagnosis, or treatment of a disease or condition.”

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