Healthcare Dive
OCTOBER 6, 2023
Medical records provided by the insurer didn’t support certain diagnosis codes, resulting in overpayments, according to an audit from the HHS’ Office of the Inspector General.
Fierce Healthcare
OCTOBER 6, 2023
million in overpayments from Medicare Advantage in 2015 and 2016. | million in overpayments from Medicare Advantage in 2015 and 2016. A new federal audit estimates that Aetna may have received at least $25.5 A new federal audit estimates that Aetna may have received at least $25.5
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Healthcare Law Today
JANUARY 2, 2023
As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.
Health Care Law Brief
JUNE 26, 2022
With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co. 3d 173 (Sep.
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. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.
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. Indest III, J.D., To read the final rule from CMS, click here.
HIT Consultant
JUNE 15, 2023
What You Should Know: Kalderos , a data infrastructure and analytics company, identified nearly $1B in inaccurate drug discount requests from 2016-Q1 2023 on its drug discount management platform. Between 2016 and Q1 2023, Kalderos’ MDRP Discount Monitoring solution identified nearly $1 billion in inaccurate discount requests.
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