CMS.gov

NOVEMBER 16, 2018

Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Director, Medicare-Medicaid Coordination Office, Topic. Medicare Parts A & B. Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report. Jeremy.Booth@c….

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Medicare Medicare Medicaid Medicaid 35

HIPAA Journal

FEBRUARY 16, 2022

The PHI of non-dental patients who received healthcare services between December 5, 2016, and August 31, 2020, was also compromised and included names, birthdates, addresses, insurance identification numbers, and Social Security numbers.

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Ransomware Hospitals Licensing HIPAA 130

Healthcare IT News - Telehealth

OCTOBER 19, 2020

Allscripts bought CarePort in 2016 to help bolster its population health management software. Earlier this summer, CarePort launched a tool to help hospitals comply with the Centers for Medicare and Medicaid Services' interoperability final rules.

Telemedicine 164

Telemedicine Medicaid Medicaid Hospitals 164

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

The Health Law Firm

NOVEMBER 17, 2015

The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its 2016 Annual Work Plan (Work Plan) on November 2, 2015, with an effective date of October 1, 2015. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

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

The Health Law Firm

MARCH 8, 2016

Board Certified by The Florida Bar in Health Law On February 26, 2016, The Centers for Medicare & Medicaid Services (CMS) extended the deadline for eligible hospitals/professionals and critical access hospitals to apply for a hardship exception from the 2015 Medicare Electronic Health Records Incentive Program.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare Law Blog

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] ILOSs must advance the objectives of the Medicaid program. ILOSs must be medically appropriate.

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Medicaid Medicaid Medicare Medicare 52

Healthcare IT News - Telehealth

JANUARY 11, 2021

In November, the Centers for Medicare and Medicaid Services took several new steps to help U.S. Previously with Medicare, programs like mine had no way to bill for care. Now this is the opportunity to bill Medicare for home hospital-level care, and this is going to be offered all across the country."

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Hospitals Medicare Medicare COVID-19 175

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Prior to 2016, large vendors controlled the market and monopolized state MMISs.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

The Health Law Firm

FEBRUARY 15, 2016

Board Certified by The Florida Bar in Health On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule which eased requirements for health care providers to return overpayments within 60 days to avoid False Claims Act (FCA) liability. By George F. Indest III, J.D.,

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Overpayments Overpayment Medicare Medicare 40

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. Care Health Plan it had initiated a compliance review and in February 2016, L.A. OCR informed L.A.

HIPAA 95

HIPAA Compliance Medicaid Medicaid 95

The Health Law Firm

MARCH 9, 2016

Board Certified by The Florida Bar in Health Law On March 1, 2016, the Centers for Medicare and Medicaid Services (CMS) suspended a Florida insurer, Ultimate Health Plans Inc.(UHP), UHP), for posing a “serious threat” to Medicare beneficiaries. Indest III, J.D., A Negative Audit From CMS.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

SEPTEMBER 18, 2023

The newest value-based payment program purposely designed to address SDOH is the ACO Realizing Equity, Access, and Community Health (ACO REACH) model, launched by the Centers for Medicare & Medicaid Services (CMS). Since 2016, Z codes have been available to capture SDOH data at the point of care delivery.

Health Outcomes 88

Health Outcomes Electronic Medical Records Medicaid Medicaid 88

Healthcare Law Blog

SEPTEMBER 6, 2023

On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited proposal to establish new federal minimum staffing standards for long-term care facilities. [1] 68754 (October 4, 2016). 55 RN hours per resident per day (the “.55 55 RN HPRD”); and At least 2.45 Nurse Aide (NA) HPRD (the “2.45

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Nursing Homes Nurses Medicaid Medicaid 98

Jane Sarashon

MARCH 3, 2025

We learned a lot about health equity and disparities during the pandemic: one key driver of health (or social determinant of health, SDoH) which had been one of my talking points since writing about it in the Huffington Post in 2016 was connectivity — the Internet kind of connection. health care.

Medical Billing 59

Medical Billing Health Insurance Doctors Electronic Medical Records 59

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

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Medicaid Medicaid Federal Policy Health Outcomes 52

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

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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Medicare Medicare Hospitals Medicaid 40

HIPAA Journal

MARCH 20, 2025

TX Healthcare Provider 3,998,163 Hacking/IT Incident 27 2016 Banner Health AZ Healthcare Provider 3,620,000 Hacking/IT Incident 28 2021 Florida Healthy Kids Corporation FL Health Plan 3,500,000 Hacking/IT Incident 29 2015 Medical Informatics Engineering IN Business Associate 3,500,000 Hacking/IT Incident 30 2016 Newkirk Products, Inc.

HIPAA 109

HIPAA Ransomware Compliance Hospitals 109

Compliancy Group

DECEMBER 20, 2024

The contractor used the ePHI to generate medical claims for services that were not actually rendered, resulting in approximately 6,500 false Medicare claims. OCR investigated the claim and found that from May of 2016 to January of 2019, the ePHI of roughly 1.5 flat fee to have the records mailed certified to her.

Ransomware 98

Ransomware HIPAA Fraud Electronic Medical Records 98

Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Overpayments Overpayment Medicare 59

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

Healthcare Law Blog

JANUARY 25, 2023

Introduction: Defining Interprofessional Consultation In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance Program (“CHIP”) policy on the coverage and payment of interprofessional consultations (the “Guidance”).

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Medicaid Medicaid Medicare Medicare 52

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

The Health Law Firm

SEPTEMBER 22, 2016

Board Certified by The Florida Bar in Health Law The Centers for Medicare & Medicaid Services (CMS) is implementing a three-year Medicare Pre-Claim Review Demonstration for Home Health Services in the states of Illinois, Florida, and Texas Michigan and Massachusetts. Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

American Medical Compliance

JUNE 21, 2024

The Department of Health and Human Services (HHS) estimated that improper payments in the Medicare and Medicaid programs exceeded $100 billion from 2016 to 2023. Moreover, as frontline defenders of the healthcare system, healthcare providers play a crucial role in preventing these issues.

Fraud 105

Fraud Compliance Medicaid Medicaid 105

The Health Law Firm

JULY 14, 2016

Board Certified by The Florida Bar in Health Law On June 30, 2016, a Florida heart surgeon agreed to pay $2 million and release any claims to $5.3 million in suspended funds allegedly owed to him because of allegations of improperly billing Medicare, Medicaid and TRICARE. Indest III, J.D., The Settlement Agreement.

Doctors 40

Doctors Medicare Medicare Medicaid 40

The Health Law Firm

DECEMBER 12, 2016

Board Certified by The Florida Bar in Health Law Walter Beich, an Illinois pharmacist, pled guilty on November 17, 2016 to defrauding Medicare, Medicaid and several private insurers out of $2.4 By George F. Indest III, J.D.,

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Fraud Medicare Medicare Medicaid 40

MedTrainer

MARCH 3, 2021

The Physician Quality Reporting System (PQRS) was first introduced over a decade ago by the Centers for Medicare and Medicaid Services (CMS) as a quality reporting program. In 2016, Healthcare providers who successfully participated in this program were listed on the new public Physician Compare webpage.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare Compliance Blog

APRIL 29, 2022

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. in restitution for her role in healthcare fraud, wire fraud, and theft of government funds.

Fraud 59

Fraud Governance Compliance Medicaid 59

The Health Law Firm

DECEMBER 21, 2016

Board Certified by The Florida Bar in Health Law On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the US Department of Justice (DOJ) announced.

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Medicaid Medicaid Doctors Medicare 40

The Health Law Firm

JANUARY 11, 2017

Board Certified by The Florida Bar in Health Law On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks.

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Medicaid Medicaid Medicare Medicare 40

The Health Law Firm

MAY 9, 2016

candidate at Tulane University: Law Clerk, The Health Law Firm On April 20, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) released updated non-binding criteria that disclosed when a company or individual can be barred from participating in Medicare, Medicaid, and other federal health care programs.

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US Department of Health and Human Services Medicaid Medicaid Medicare 40

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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Medicaid Medicaid Medicare Medicare 52

Health Populi

OCTOBER 24, 2018

This feeling of political stress was uncovered at the time of the 2016 U.S. But this week, the Centers for Medicare and Medicaid Services issued “State Relief and Empowerment Waivers” that allow each of the 50 U.S. Note the fifth factor, worrying about the state of the country.

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Public Health Medicaid Medicaid Doctors 78