HIT Consultant

AUGUST 7, 2024

Despite the Challenges, CHCs Remain a Beacon of Hope This news comes amidst a backdrop of rising mental health and substance use treatment needs, fluctuating Medicaid enrollment patterns, and persistent funding gaps. In 2024, 67% of CHCs reported screening all patients, compared to only 40% in 2018.

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Bill of Health

MARCH 24, 2023

US Food and Drug Administration Approval of Drugs Not Meeting Pivotal Trial Primary End Points, 2018-2021. Market dynamics of authorized generics in Medicaid from 2014 to 2020. JAMA Intern Med. 2022 Dec 1;182(12):1321-1323. Johnston JL, Ross JS, Ramachandran R. JAMA Intern Med. 2023 Feb 13:e226444. Epub ahead of print. JAMA Intern Med.

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Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018. This total includes $41.1

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Medicare Medicare Overpayments Overpayment 98

HealthStream

DECEMBER 19, 2019

Leaders are looking to optimize software solutions which provide methods to improve efficient communication and required payer ongoing verifications, as well as integration with the Council for Accountable Quality Healthcare (CAQH), State Medicaid, and Medicare enrollment.

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Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. See also Ratanasen v.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Bill of Health

MARCH 25, 2022

Medicaid Expenditures and Estimated Rebates on Line Extension Drugs, 2010-2018. New EU regulation on health technology assessment of cancer medicines. Lancet Oncol. 2022 Feb;23(2):e58. PMID: 35114127. Hwang TJ, Feng J, Maini L, Kesselheim AS. J Gen Intern Med. 2022 Feb 22. Epub ahead of print. PMID: 35194743.

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FDA COVID-19 Medicaid Medicaid 209

HIT Consultant

JUNE 12, 2024

Additionally, the Centers for Disease Control and Prevention reported a 39% increase in SUD cases in emergency departments (ED) from 2018 to 2021, exacerbating issues of overcrowding and overspending. Department of Health and Human Services revealed that in 2022, 17% of people aged 12 or older reported a substance use disorder (SUD).

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Medicaid Medicaid Medicare Medicare 98

C&M Health Law

DECEMBER 21, 2022

HHS also adopted the NCPDP Batch Standard Medicaid Subrogation Implementation Guide, Version 3, Release 0 (Version 3.0) Since 2018, NCHVS has issued recommendations to adopt the following standards: NCPDP Telecommunications Standard Implementation Guide Version F6 (to replace Version D.0);

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HIPAA Medicaid Medicaid Health Insurance 52

Bill of Health

MAY 19, 2022

from 2018-2019. Therapeutic Value Assessments of Novel Medicines in the US and Europe, 2018-2019. A full posting of abstracts/summaries of these articles may be found on our? Aboy M, Liddell K, Jordan M, Crespo C, Liddicoat J. European patent protection for medical uses of known products and drug repurposing. JAMA Oncol.

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Health Insurance Hospitals FDA Medicaid 209

Healthcare Law Blog

JANUARY 25, 2023

Introduction: Defining Interprofessional Consultation In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance Program (“CHIP”) policy on the coverage and payment of interprofessional consultations (the “Guidance”).

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Medicaid Medicaid Medicare Medicare 52

Bill of Health

OCTOBER 17, 2024

SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit. AB 3030 requires that health care providers disclose when they have used generative AI to create communications with patients.

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Medicare Medicare Health Insurance Licensing 150

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Tue, 10/02/2018 - 15:36. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c…. Seema Verma.

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CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. percent in 2018. percent in 2018.

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Medicare Medicare Overpayments Overpayment 20

Compliancy Group

JULY 15, 2022

The information accessed included patient names, Medicaid numbers, healthcare provider names, dates of service, dates of birth, addresses, and treatment information. The university announced the HIPAA breach on January 5, 2018.

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HIPAA Medicaid Medicaid Compliance 97

Healthcare IT Today

AUGUST 14, 2024

The Centers for Medicare and Medicaid Services reported more than 45% of provider office locations listed in online directories contained at least one error. A study ( “What Physicians are Saying About Directories” American Medical Association, 2018. However, much of this provider data has a short shelf life.

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Fraud Hospitals Medicaid Medicaid 71

HIT Consultant

NOVEMBER 2, 2023

This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model.

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Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

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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.

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Medicaid Medicaid Health Outcomes State Policy 52

Kaiser Health News

MARCH 15, 2022

But the new benefit for people enrolled in Medi-Cal, the state’s Medicaid health insurance program, has been delayed twice as the state and doulas — nonmedical workers who help parents before, during, and after birth — haggle over how much they should get paid.

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Medicaid Medicaid Health Insurance Public Health 89

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.

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Fraud Doctors Medicare Medicare 59

Hall Render

JULY 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. CMS has proposed that 340B hospitals will receive a one-time lump sum payment at the end of 2023 or beginning of 2024.

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Hospitals Medicaid Medicaid Medicare 40

HIPAA Journal

JULY 15, 2022

OCR launched a HIPAA investigation after receiving a breach report on January 5, 2018, in response to the hacking of an OSU-CHS web server. OSU-CHS determined that malware had been installed on the server which allowed the hacker(s) to access the electronic protected health information of 279,865 individuals.

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HIPAA Compliance Medicaid Medicaid 133

Healthcare Law Blog

MARCH 25, 2022

In February 2018, a district court in New Mexico vacated HHS’s risk-adjustment rules for benefit years 2014 through 2018 to the extent the rules relied on the third step of HHS’s methodology. Then, in July 2018, HHS announced it would republish the previously adopted risk-adjustment rule for the 2017 benefit year.

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ACA US Department of Health and Human Services Health Insurance Medicaid 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.

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Medicaid Medicaid Governance Fraud 59

Provider Trust

JULY 26, 2023

The Centers for Medicare and Medicaid Services (CMS) conducted multiple reviews of Medicaid Advantage provider directories between February 2016 and July 2018. However, Medicaid Advantage plans aren’t alone in this problem. Unfortunately, provider directories are often riddled with inaccuracies.

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Medicaid Medicaid Compliance Medicare 52

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). 2018), rev’d in part on other grounds sub nom. FOOTNOTES. [1] 1] See UnitedHealthcare Ins. Azar , 330 F. 3d 173 (D.D.C. Becerra , 16 F.4th

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Overpayments Overpayment Medicare Medicare 98

HIT Consultant

JUNE 25, 2024

Researchers analyzed data from over 22,000 patients with newly diagnosed HCC between 2015 and 2018. The registry offers a de-identified dataset encompassing Medicare, Medicaid, commercially insured, and Medicare Advantage patients.

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Medicare Medicare Medicaid Medicaid 52

Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. As part of the settlement, the doctor will pay a total of more than $9.48

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Fraud Doctors Elder Abuse Medicare 59

HIT Consultant

MARCH 30, 2023

The platform allows connectivity to the key services providers require to address patient needs including prescription delivery, stress-free rides, and soon, the delivery of healthy food and over-the-counter medicine for those who need it most—including Medicare Advantage and Medicaid beneficiaries.

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Medicaid Medicaid Medicare Medicare 98

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.

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Medicare Medicare Medicaid Medicaid 59

Health Populi

DECEMBER 4, 2019

With new rules emanating from the White House this month focusing on health care price transparency, health care costs are in the spotlight at the Centers for Medicare and Medicaid Services. Read my post on getting transparent about transparency in Medecision’s blog here for more details and a deeper dive into this important issue.

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Medicaid Medicaid Medicare Medicare 83

Healthcare IT News - Telehealth

OCTOBER 19, 2020

In the suit, the EHR giant argues that it has used the CarePort trademark since 2013 and that in 2018 the telemedicine company changed its name from ER at Home to CarePortMD. In 2018, CarePort Health took over management of AllScripts' Care Management technology to aid with acute-case management and post-acute referrals.

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HIT Consultant

APRIL 3, 2023

Progress toward VBC adoption hasn’t achieved its potential yet, hovering around 60% of all payment models from 2018 to 2021, with the remaining 40% comprised of traditional fee for service (FFS).

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Medicaid Medicaid Medicare Medicare 98

The Health Law Firm

SEPTEMBER 25, 2018

Board Certified by The Florida Bar in Health Law On August 22, 2018, a doctor received a sentence of one year and a day in prison from a New York federal court for his part in a $30 million scheme to defraud Medicare and the state Medicaid program. Indest III, J.D.,

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Fraud Doctors Medicaid Medicaid 40

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

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Nursing Homes Medicaid Medicaid Medicare 52

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.

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Telemedicine Medicaid Medicaid Malpractice 98

Health Populi

JUNE 27, 2022

The second bar chart illustrates the per member/per month (PMPM) spend for commercially insured workers, showing growth of over 7% from 2018 to 2019, and nearly 7% drop from 2019 to 2020 in the first year of the pandemic. But flat growth is expected for 2022, Castlight forecasts.

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