Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. Deceiving MassHealth: The Disturbing Truth Behind Dental Services From 2014 to 2018, a shocking scheme unfolded within the realm of dental services.

Fraud 52

Fraud Medicaid Medicaid Governance 52

Health Populi

FEBRUARY 21, 2019

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs. National health spending in the U.S.

Medicare 91

Medicare Medicare Medicaid Medicaid 91

Health Populi

FEBRUARY 6, 2018

Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), has assembled a diverse group of health care leaders who care about those patients/people, too, appropriately named the United States of Care. That is, U.S.

Health Insurance 89

Health Insurance Medicaid Medicaid Medicare 89

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

Physician Credentialing Company

DECEMBER 20, 2024

Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. Legal and financial risks For not following government and payer-specific guidelines, providers may have to bear legal penalties in terms of finances or exclusion from the program. Each payer has its own policies and rules for billing.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 52

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

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

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

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

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

Kaiser Health News

JULY 11, 2023

The public school system here had to scramble in 2018 when the local hospital, newly purchased, was converted to a tax-exempt nonprofit entity. Hospitals also claim as community benefits the difference between what it costs to provide a service and what Medicaid pays them, known as the Medicaid shortfall. POTTSTOWN, Pa. —

Hospitals 72

Hospitals Medicaid Medicaid Medical Billing 72

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

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 17, 2025

There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. The Data Speaks Data gathered in 2018 was a sign of things to come.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

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

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

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

NOVEMBER 2, 2021

Today, patients are the third-largest payer – behind Medicaid and Medicare. In 2018, 14.2% – Insurance and government payers: The Centers for Medicare and Medicaid Services (CMS) required hospitals to make pricing more transparent beginning in 2021. Let’s begin by looking at what providers can do.

Hospitals 52

Hospitals Patient Advocacy Medicaid Medicaid 52

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

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

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

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

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 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

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

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

Health Populi

MAY 6, 2018

Universal health care was covered in a section on 28 April 2018, and coverage on financial inclusion was bundled into the 5th May edition. Two weeks in a row, The Economist , the news magazine headquartered in London, included two special reports stapled into the middle of the magazines.

Medicaid 54

Medicaid Medicaid Medicare Medicare 54

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

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

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

Healthcare It News

MARCH 18, 2022

Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. Notably, since 2018, mental health has been the top clinical indication to receive investment, growing from $1.4 billion that year to $5.1 billion in 2021, according to Rock Health.

Medicaid 362

Medicaid Medicaid COVID-19 Telemedicine 362

Pharmacy Law Blog

MAY 7, 2018

This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. Copyright © 2018 The Health Law Firm. You do not have to report a pending DOH investigation against you to anyone. a Florida professional service corporation, since 1999.Copyright

Licensing 40

Licensing Nurses Medicaid Medicaid 40

Pharmacy Law Blog

MAY 14, 2018

This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. Copyright © 2018 The Health Law Firm. You do not have to report a pending DOH investigation against you to anyone. a Florida professional service corporation, since 1999.Copyright

Licensing 40

Licensing Nurses Medicaid Medicaid 40

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

Healthcare Law Blog

NOVEMBER 21, 2022

Pharmaceutical manufacturers are challenging the breadth of the Federal Anti-Kickback Statute (“AKS”) in federal court, arguing that the government is harming the very vulnerable patients it aims to serve by prohibiting cost-sharing subsidies for life-saving oncology drugs. 10, 2018). [5] Doshi et al., of Clinical Oncology 5 (Feb.

Medicare 52

Medicare Medicare Governance Medicaid 52

Kaiser Health News

JANUARY 6, 2022

South Dakota voters will decide in November whether the state should become the 39th to expand Medicaid under the Affordable Care Act, a move that would provide coverage to 42,000 low-income residents. Kristi Noem, a Republican, strongly opposes Medicaid expansion, even though the federal government picks up most of the cost.

Medicaid 126

Medicaid Medicaid ACA Governance 126