HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. According to the FBI, more than $43 billion was lost to these scams between June 2016 and December 2021, and in 2021 alone, the FBI Internet Crime Complaint Center received reports of losses of $2,395,953,296 to BEC scams. million, and $6.4

Medicaid 100

Medicaid Medicaid Medicare Medicare 100

Bill of Health

DECEMBER 27, 2022

Frequency of Approval and Marketing of Biosimilars With a Skinny Label and Associated Medicare Savings. High-risk Therapeutic Devices Approved by the US Food and Drug Administration for Use in Children and Adolescents From 2016 to 2021. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

Bill of Health

NOVEMBER 17, 2022

Fulfillment of Postmarket Commitments and Requirements for New Drugs Approved by the FDA, 2013-2016. Medicare’s National Coverage Determination for Aducanumab – A One-Off or a Pragmatic Path Forward? Brown BL, Mitra-Majumdar M, Darrow JJ, Moneer O, Pham C, Avorn J, Kesselheim AS. JAMA Intern Med. 2022 Oct 3:e224226.

FDA 189

FDA World Health Medicaid Medicaid 189

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…. Tim Engelhardt.

Medicare 35

Medicare Medicare Medicaid Medicaid 35

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

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

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. Health Populi’s Hot Points: U.S. households.

ACA 139

ACA Health Insurance Medicaid Medicaid 139

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

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

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.

Ransomware 130

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

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). Fear not, gentle reader. most hospitals).

HIPAA 113

HIPAA Hospitals Medicare Medicare 113

HIT Consultant

FEBRUARY 28, 2022

Patient care is covered by Medicare and is available under most major insurance providers. Founded in 2016, XRHealth is the first company to create virtual reality clinics that provide remote care to patients throughout the United States and is covered by most major health insurance companies as well as medicare.

Medicare 98

Medicare Medicare FDA Health Insurance 98

Health Populi

APRIL 8, 2019

That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement. The $285K also assumes the couple doesn’t have employer-sponsored retiree health care coverage and qualifies for “Original Medicare” (not Medicare Advantage, for example).

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108

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."

Hospitals 175

Hospitals Medicare Medicare COVID-19 175

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

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.,

Medicare 40

Medicare Medicare Fraud Governance 40

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.,

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

The Health Law Firm

FEBRUARY 20, 2016

Board Certified by The Florida Bar in Health Law On February 9, 2016, the D.C. Circuit ordered the US District Court for the District of Columbia to reconsider a lawsuit seeking to compel the Department of Health and Human Services (HHS) to meet statutory deadlines for reviewing Medicare claims denials. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Hospitals 40

HIT Consultant

NOVEMBER 2, 2021

In 2016, the Centers for Medicare and Medicaid Services (CMS) followed by issuing guidance on how states should move forward with modularity of their MMIS with a goal of providing enhanced flexibility to change systems. Prior to 2016, large vendors controlled the market and monopolized state MMISs. Current State of the Market.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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

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.,

Fraud 40

Fraud Medicare Medicare Governance 40

Electronic Health Reporter

MARCH 26, 2019

Pharmaceutical manufacturers face growing pressure from legislators, employers and consumers to control prescription drug costs, which have increased by as much as 15 percent between 2008 and 2016. In late February, a congressional committee grilled executives from seven pharmaceutical companies over relentless price hikes and […].

Medicare 96

Medicare Medicare 96

Health Populi

MARCH 27, 2018

The latest data on health care costs in retirement was published by EBRI earlier this year in their report , Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $370,000, Up from $350,000 in 2016. increase in one year. Here’s EBRI’s big table with the big number.

Medicare 83

Medicare Medicare Doctors 83

The Health Law Firm

DECEMBER 6, 2016

Board Certified by The Florida Bar in Health Law On December 1, 2016, Sheila Kahl pled guilty in a New Jersey federal court that she took part in a $1 million Medicare fraud scheme. The participants in the scheme received "commissions" each time the labs were paid by Medicare or a private insurer. By George F. Indest III, J.D.,

Fraud 40

Fraud 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 96

HIPAA Compliance Medicaid Medicaid 96

The Health Law Firm

FEBRUARY 12, 2016

Board Certified by The Florida Bar in Health Law A central Florida ophthalmologist with offices in Windermere and Leesburg, was found guilty of 20 counts of Medicare fraud on September 29th. He will remain in custody as he awaits his sentencing which is currently scheduled for March 14, 2016. Indest III, J.D., David Ming Pon, M.D.,

Fraud 40

Fraud Medicare Medicare Doctors 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) ).

Medicare 40

Medicare Medicare Hospitals Medicaid 40

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.,

Medicare 40

Medicare Medicare Hospitals Governance 40

The Health Law Firm

JULY 13, 2016

Board Certified by The Florida Bar in Health Law On June 22, 2016, Federal officials completed a three-day nationwide takedown announcing charges against 301 medical professionals who allegedly defrauded Medicare of more than $900 million in fraudulent billings. By George F. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare 40

The Health Law Firm

MAY 1, 2016

Board Certified by The Florida Bar in Health Law On April 18, 2016, Dr. Henry Lora, a doctor in Miami was sentenced to nine years in federal prison for his role in a scheme to defraud the Medicare system out of around $30 million in phony reimbursements. By George F. Indest III, J.D.,

Fraud 40

Fraud Doctors Medicare 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. By George F.

Nursing Homes 40

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

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

Nursing Homes 98

Nursing Homes Nurses Medicaid Medicaid 98

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

HIT Consultant

NOVEMBER 24, 2022

Health plans could, for example, consider covering OTC hearing devices as part of the hearing benefits package provided to their Medicare Advantage plan members. For Medicare Advantage plans, a positive member experience is critical in achieving 5-star ratings. Epub 2016 Aug 23. million U.S. million have moderate hearing loss.

FDA 98

FDA Public Health Fraud Medicare 98

Bill of Health

JULY 26, 2022

Amazon now has an important foothold in the Medicare market. Department of Health and Human Service estimates , the total per capita lifetime health spending (in 2016 dollars) is $414k; if health care spend increases 3% greater than overall inflation (quite likely), that number would be $2.3 Now let’s dream a little. According to U.S.

US Department of Health and Human Services 173

US Department of Health and Human Services Health Insurance HIPAA Medicare 173

Health Populi

MAY 10, 2021

I’ve tracked this survey for over a decade here on Health Populi, and updated the annual chart shown here to reflect a $40,000 increase in retiree costs since 2016. To pay for health care expenses, the average nest-egg required for a couple retiring in the U.S.

COVID-19 119

COVID-19 Health Insurance Medicare Medicare 119