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.

Medicare 105

Medicare Medicare Overpayment Overpayments 105

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.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Fierce Healthcare

NOVEMBER 2, 2023

The Centers for Medicare & Medicaid Services has dropped the final rule to remedy the invalidated 340B-acquired drug payment policy for calendar years 2018 to 2022. |

Hospitals 117

Hospitals Medicare Medicare Medicaid 117

Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. The total amount of the penalties is determined by how much each hospital bills Medicare.

Medicare 127

Medicare Medicare Hospitals COVID-19 127

Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. Characteristics of Prior Authorization Policies for New Drugs in Medicare Part D. 2023 Feb 23.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

Healthcare IT News - Telehealth

MAY 13, 2020

Although research supported the efficacy of video telepsychiatry, the National Institute of Mental Health-funded study notes, only 5% of psychiatrists in the Medicare program had ever provided a telemedicine visit. The shift to telemedicine was made simpler, researchers note, by regulatory and reimbursement changes.

Telemedicine 218

Telemedicine COVID-19 HIPAA Medicare 218

Healthcare IT News - Telehealth

JUNE 26, 2020

Throughout 2018 and 2019, Northwell Health piloted small-scale programs in partnership with the Gary and Mary West Health Institute Collaboration to bring medical services virtually to the homes of their patients. "I know their baseline and when they call, I send the [mobile telemedicine technicians] there."

COVID-19 202

COVID-19 Telemedicine Medicaid Medicaid 202

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.

Telemedicine 162

Telemedicine Medicaid Medicaid Hospitals 162

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.

FDA 208

FDA COVID-19 Medicaid Medicaid 208

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.

Health Insurance 208

Health Insurance Hospitals FDA Medicaid 208

Compliancy Group

DECEMBER 20, 2024

The attacks affected the electronic protected health information (ePHI) of approximately 85,000 individuals between February and March of 2018. In May of 2018, Gulf Coast hired an independent contractor to provide business consulting services. HIPAA 2024 Year in Review: Gulf Coast In early December of 2024, OCR announced a $1.19

Ransomware 98

Ransomware HIPAA Fraud Electronic Medical Records 98

Healthcare IT News - Telehealth

APRIL 24, 2020

The Alliance for Integrated Care of New York (AICNY) oversees the healthcare needs of roughly 6,200 dually eligible Medicare and Medicaid beneficiaries with intellectual and developmental disabilities (IDD). Over three quarters of 2018, AICNY inpatient expenditures saw a 6% reduction. THE PROBLEM. ” PROPOSAL. MARKETPLACE.

Telemedicine 197

Telemedicine COVID-19 Medicaid Medicaid 197

Healthcare IT News - Telehealth

APRIL 9, 2019

The ability of such analytics to both assess patients in the moment and point toward their potential future condition had health systems investing more than $566 million in the technology during 2018, the report notes.

Hospitals 167

Hospitals Medicaid Medicaid Medicare 167

Healthcare IT Today

APRIL 4, 2025

Nationally, the Centers for Medicare & Medicaid Services (CMS) has reported that only 18% of TCM visits were billed. Hospitals experience an average of 17 readmissions per 100 Medicare discharges. Since its inception in 2018, NEC X has helped launch and grow more than 130 startups. Ignite and Elev X!

Records Management 52

Records Management Hospitals Medicare Medicare 52

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

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

Healthcare Law Blog

MAY 16, 2022

More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. In 2018, DHCS also launched the HHP pilot. In 2015, DHCS launched the WPC Pilots as part of its Medi-Cal 2020 Section 1115 Demonstration.

Medicaid 59

Medicaid Medicaid Nurses Health Care Access 59

Natalia Mazina

FEBRUARY 22, 2024

DIR fees were implemented with the creation of the Part D program through the passage of the Medicare Modernization Act of 2003. 2 As of 2018, DIR fees have increased to over six percent of the overall Medicare drug sales. There are three coverage phases in a Medicare recipient’s drug design.

Medicare 137

Medicare Medicare Patient Advocacy Medicaid 137

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. UnitedHealthcare challenged the current Overpayment Rule in litigation. [1]

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Health Populi

AUGUST 24, 2020

Four in five large employers believe virtual health will play a significant role in how care is delivered int he future, up from 64% in 2019 and 52% in 2018. On the payor front, large U.S. Furthermore, nine in ten companies plans to offer virtual care for telemental health, a fast-growing aspect of virtual care.

COVID-19 154

COVID-19 Telemedicine Doctors Medicare 154

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.

Medicaid 83

Medicaid Medicaid Medicare Medicare 83

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).

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

HIPAA Journal

MARCH 20, 2025

2023, OCR reported a 239% increase in hacking-related data breaches between January 1, 2018, and September 30, 2023, and a 278% increase in ransomware attacks over the same period. PA Business Associate 2,675,934 Hacking/IT Incident 45 2018 AccuDoc Solutions, Inc. In 2019, hacking accounted for 49% of all reported breaches.

HIPAA 111

HIPAA Ransomware Compliance Hospitals 111

Healthcare IT News - Telehealth

MARCH 4, 2019

As a federally qualified health center, Vista Community Clinic is a safety net for its neighborhood, managing an uninsured or underinsured patient population – in this case, 58 percent Medicaid, 2 percent Medicare and 32 percent uninsured. THE PROBLEM.

Telemedicine 164

Telemedicine Medicaid Medicaid Medicare 164

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).

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

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.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. As we predicted in February , this Final Rule is now being challenged in court.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

The Health Law Firm

SEPTEMBER 24, 2018

Board Certified by The Florida Bar in Health Law On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. Indest III, J.D., Section 15.5.3 Section 15.5.3 New Language Basics.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Verisys

APRIL 1, 2025

When the Centers for Medicare and Medicaid Services ( CMS ) Medicare Preclusion List went into effect in 2019, it added restrictions on Medicare payments to certain providers. Key details about the Preclusion List : It applies only to Medicare Advantage items and services or Part D drugs for Medicare beneficiaries.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

The Health Law Firm

OCTOBER 31, 2019

billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice medicine. The vast fraud scheme totaled $2.1 This appears to be a new national record.

Fraud 40

Fraud Medicare Medicare Doctors 40

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 52

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. Medicare and Medicaid data demonstrated that he was identified as an outlier and the highest biller for this procedure in New York State.

Fraud 59

Fraud Doctors Medicare Medicare 59

Health Populi

DECEMBER 6, 2018

In 2006, Medicare Part D launched, which may have boosted consumers’ faith in Federal healthcare programs. Now, in late 2018, we look toward 2019 and the 2020 Presidential elections and must also contemplate the lower darker green line. Most people in the U.S. That’s the top lighter green line in the first chart.

Governance 73

Governance Medical Billing Medicaid Medicaid 73

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.

COVID-19 125

COVID-19 Health Insurance Medicaid Medicaid 125

The Health Law Firm

AUGUST 10, 2018

Board Certified by The Florida Bar in Health Law On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment policies, payment rates, and quality provisions for services rendered under the Medicare Physician Fee Schedule (PFS). Indest III, J.D.,

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare Compliance Blog

JANUARY 14, 2022

million to settle allegations that the company sold custom fabricated shoe inserts to Medicare recipients that did not meet Medicare standards. Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. A Florida based diabetic shoe company has agreed to pay over $5.5

Medicare 59

Medicare Medicare Medicaid Medicaid 59