Healthcare Compliance Blog

JANUARY 14, 2022

Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. The United States alleges that between 2013 and 2018 the shoe company sold diabetic shoe inserts that were represented to be custom made for an individual’s foot but were actually made using generic foot models.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

HIT Consultant

NOVEMBER 7, 2024

Despite these challenges, there is an immense opportunity for the healthcare system, particularly Medicaid, to play a transformative role in addressing health equity for this population. One significant legislative effort to promote such collaboration is the Family First Prevention Services Act (FFPSA ), signed into law in 2018.

Medicaid 52

Medicaid Medicaid Health Outcomes State Policy 52

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. The federal government has been haranguing vendors and clinicians to make interoperable systems since the HITECH act was passed in 2009. The release of FHIR in the mid-2010 decade changed everything.

Electronic Medical Records 112

Electronic Medical Records Doctors Governance Medicaid 112

Hall Render

AUGUST 8, 2022

In January 2018, the University notified OCR of a breach of ePHI that affected 279,865 individuals and occurred in November 2017. The web server contained ePHI, including patients’ names, Medicaid numbers, health care provider names, dates of service, dates of birth, addresses and treatment information.

HIPAA 73

HIPAA Governance Medicaid Medicaid 73

HIT Consultant

AUGUST 5, 2022

Predictions regarding Home Care and Medicaid Outlook: As a general observation, Stout thinks that many states will increase reimbursement rates and funding for Medicaid recipients, who have often had difficulty accessing quality home care due to providers declining to participate in government-funded programs.

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 98

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 Errors identified in already completed audits will be extrapolated more aggressively for audits going back to 2018, and then going forward for new audits. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare IT News - Telehealth

JUNE 12, 2024

Centers for Disease Control said it measured 39% more SUD cases between 2018 and 2021, according to the company. million lives across Medicaid and commercial contracts," Abhinav Shashank, cofounder and CEO at Innovaccer, said in the announcement. "Pediatric Associates has an impressive track record in managing over 1.5

Hospitals 126

Hospitals COVID-19 Medicaid Medicaid 126

McGuire Wood

OCTOBER 2, 2023

times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. This settlement includes more than $5.928 million in restitution, essentially a payment of 1.49

Fraud 52

Fraud Governance Compliance Medicare 52

Hall Render

JUNE 15, 2022

Becerra , the Supreme Court ruled the payment cuts made by the Department of Health and Human Services’ (“HHS”) Centers for Medicare & Medicaid Services (“CMS”) for 340B eligible outpatient drugs were not permissible under the governing statute. for 340B eligible hospitals.

Medicare 45

Medicare Medicare Hospitals Governance 45

HIT Consultant

MARCH 7, 2023

According to the AMA , studies conducted in 2018 showed that “most patients only take their medicine as prescribed about half the time and are often reluctant to tell their doctor, while a quarter of new prescriptions are never filled.” It also costs $290 billion annually in increased medical costs.

Doctors 98

Doctors Medicaid Medicaid Governance 98

MedTrainer

NOVEMBER 29, 2023

For healthcare compliance programs in Indiana to be successful, organizations must have methods in place for tracking and applying regulatory standards, while ensuring all staff are up to date with changes by governing bodies. This article provides an overview of the important aspects to healthcare compliance specific to Indiana State.

Compliance 52

Compliance Licensing Governance Public Health 52

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Enrollee Participation in Plan Governance (§ 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Health Populi

AUGUST 24, 2018

The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014 , published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. We need all hands on deck: in the kitchen, grocery stores and retailers, schools, doctors’ offices, and government agencies.

Public Health 72

Public Health Doctors Medicaid Medicaid 72

Healthcare IT Today

AUGUST 24, 2023

Today’s announcement marks Waystar’s eighth acquisition since 2018, following the strategic additions of organizations like Recondo , eSolutions , and Patientco. Waystar is trusted by 1M+ providers, 1K+ hospitals, and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers.

Patient Satisfaction 52

Patient Satisfaction Medicaid Medicaid Medicare 52

Health Populi

NOVEMBER 1, 2018

And maintaining good mental health and staying on-track with health goals come close to managing uncovered costs, Oliver Wyman’s 2018 consumer survey learned. But this time around, polling health-insured consumers in July 2018, Oliver Wyman perceives a change in consumers’ “willingness to try new kinds of health services.”

Health Insurance 73

Health Insurance Doctors Medicaid Medicaid 73

AIHC

AUGUST 8, 2023

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

COVID-19 40

COVID-19 Governance Hospitals Medicaid 40

Kaiser Health News

FEBRUARY 8, 2022

The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. Other hospitals declined to comment or did not respond to emails.

Medicare 127

Medicare Medicare Hospitals COVID-19 127

HIT Consultant

SEPTEMBER 12, 2022

Data from 2020 demonstrate almost zero change from 2018 in the proportion of straight Fee-for-Service (FFS) reimbursement. Government and private insurers are increasing the pressure on providers. Other results show a slight uptick in APMs with or without downside risk at 34.6 However, only 6.7

Pharmaceutical Industry 52

Pharmaceutical Industry Medicaid Medicaid Hospitals 52

Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Fraud 52

Fraud Governance Licensing FDA 52

Healthcare Law Blog

JANUARY 13, 2022

Let’s talk about fixing the huge American diabetes problem, providing better healthcare for Medicaid and dual eligible beneficiaries, and helping people beat cancer. Making Medicaid Better and Physicians More Accessible: Cityblock Health and ZocDoc. Did you know that on average one of every two babies today is born on Medicaid?

COVID-19 52

COVID-19 Medicaid Medicaid Doctors 52

HIT Consultant

AUGUST 15, 2022

– Government support and benefit flexibility (e.g., – Innovation-driven initiatives from the Centers for Medicare & Medicaid Services (CMS). Key trends are influencing this growth, including: – An aging population. – Continued increase in overall Medicare costs. Case in Point.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT News - Telehealth

JUNE 3, 2021

He earned a HIMSS Davies Award of Excellence in 2018. Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services. Before that, he spent 17 years as CEO of HealthPartners, a cooperatively governed health plan and care system in Minnesota. Dr. Stephanie Lahr.

COVID-19 98

COVID-19 Department of Veterans Affairs COVID-19 Vaccine Nurses 98

CMS.gov

OCTOBER 31, 2018

Wed, 10/31/2018 - 17:03. Administrator, Centers for Medicare & Medicaid Services`. Medicaid & CHIP. We’ve heard loud and clear that states want room to explore new ways of delivering care and designing programs to help their Medicaid beneficiaries live healthier, more independent lives. Jeremy.Booth@c…. Seema Verma.

Medicaid 51

Medicaid Medicaid Medicare Medicare 51

Med Law Blog

MAY 1, 2023

Tenet went through its own bankruptcy difficulties and, in 2018, sold its remaining Philadelphia assets, i.e. Hahnemann Hospital and St. Hahnemann was acquired by AHERF, the forerunner of Allegheny Health Network, in 1993. Tenet Healthcare bought Hahnemann out of the AHERF bankruptcy in 1998.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

HIPAA Journal

JULY 24, 2023

HHS was one of the first Departments to have an Office of Inspector General in 1976 due to billions of dollars being lost each year to Medicaid fraud. HHS OIG alleged that the organization had billed New York Medicaid for services furnished by the personal assistant. What is the HHS OIG Exclusions List?

Fraud 52

Fraud Medicare Medicare Medicaid 52

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. The higher the ratings, the larger the bonus payments health plans receive from the government. Centers for Medicare & Medicaid. Centers for Medicare & Medicaid.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. Prior to appealing a Medicare, Medicaid, TriCare or other Federal Program claim, you should verify that your organization is compliant in this area ( click here ).

Fraud 52

Fraud Medicare Medicare Compliance 52

Health Populi

JUNE 20, 2019

In fact, Kroger Health is the umbrella under which all of the food chain’s health and wellness assets fit: Kroger struck a deal with GoodRx in December 2018 to expand its prescription drug discount program. Intriguingly, government agencies tie at one in five people for both being on my side and working against me.

Doctors 73

Doctors Governance FDA Medicaid 73

Health Law Gurus

MAY 22, 2019

The Centers for Medicare and Medicaid Services (CMS) is launching new value-based programs with great fervor as a central strategy to bend the healthcare cost curve. Apple hired their first 50 physicians in 2018. CMS is now acting to maximize the sharing and transparency of healthcare data directly to consumers. Sound far-fetched?

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment. Physical Therapy 3.30

Medicare 52

Medicare Medicare Payment Systems COVID-19 52

Health Populi

MARCH 1, 2018

This report was published just-in-time as we convene to meet at HIMSS 2018, the largest annual health technology conference. Last year I gave a talk about social determinants of health at HIMSS, which hadn’t been a topic that was much-discussed in previous years’ meet-ups.

Health Insurance 82

Health Insurance Medicaid Medicaid Public Health 82

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

CMS.gov

JULY 18, 2018

Thu, 07/19/2018 - 00:03. Administrator, Centers for Medicare & Medicaid Services. We see health IT systems that work seamlessly with each other, and a government that supports secure data sharing and emerging technologies so that healthcare in America is better and less expensive. CMS Doubling Down on Health IT; Patients.

Medicare 35

Medicare Medicare Governance Medicaid 35

Health Populi

SEPTEMBER 17, 2020

In fact, the number of uninsured Americans rose by 2 million people in 2018 , and by 1.9 In addition, people living in states that failed to expand Medicaid as part of the Affordable Care Act provisions were also at greater risk of inadequate coverage. million people in 2017.

COVID-19 62

COVID-19 Health Insurance Public Health Health Care Access 62

CMS.gov

OCTOBER 2, 2018

Tue, 10/02/2018 - 13:57. Administrator, Centers for Medicare & Medicaid Services. It’s no secret that the government often moves more slowly than private industry — some of our payment policies haven’t been updated in decades. Modernizing Medicare to Take Advantage of the Latest Technologies. Jeremy.Booth@c…. Seema Verma.

Medicare 44

Medicare Medicare Payment Systems FDA 44