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An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000. According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. List of Excluded Individuals/Entities ?
His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare.
A home healthservices company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home healthservices provided to beneficiaries living in Florida.
An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.? to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program.
Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. See Vista Health Plan, Inc. United States Dep’t of Health & Hum. The Risk-Adjustment Program.
The Centers for Medicare & MedicaidServices (“CMS”), on behalf of the U.S. Department of Health and HumanServices (“HHS”), recently issued a proposed rule to adopt standards under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) for “health care attachment” transactions (the “Proposed Rule”).
Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Department of Health & HumanServices ( HHS ). monitorship or reporting obligations).”
This builds on the HIPAA Transactions Rule standards for financial and administrative transactions among health care providers and health plans and aligns with Department of Health and HumanServices (HHS) interoperability regulations.
At first glance, the Department of Health and HumanServices’ Office for Civil Rights HIPAA enforcement for the year 2022 appears to be lax. In 2022, OCR entered into 20 resolution agreements with HIPAA-covered entities, and imposed civil monetary penalties on two more. 22 cases total. . One Security Rule violation case.
The Centers for Medicare & MedicaidServices (CMS) in April expanded the Medicare Diabetes Prevention Program (MDPP) , a national performance-based payment model offering a new approach to type 2 diabetes prevention in eligible Medicare beneficiaries with an indication of pre-diabetes. Initiatives. Leadership.
Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.” The result?
Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.” The result?
FDA halts use of antibody drugs that don’t work vs. omicron. Safety-net hospitals face the worst of the US’ nursing shortage. State health officer discusses Alabama’s COVID-19 peak. Alabama lawmakers talking about how to use next round of federal pandemic relief funds.
Julie Rovner is Chief Washington Correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” ” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A-Z,” now in its third edition.
NATIONAL 6 health systems using GPT and AI tools 100,000 nurses left industry during the pandemic, report finds AHA backs bill to delay Medicaid DSH cuts by 2 years AHA launches info hub for healthcare quality leaders AHA opposes MedPAC recommendations to Congress on site-neutral, Part B drug, wage index policies AHA ramps up 340B protection efforts (..)
Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” ” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
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