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

Electronic Health Reporter

NOVEMBER 28, 2018

As widely reported, based on exit polls, healthcare—not the economy—was the top issue on voters’ minds in the 2018 midterm elections. The article The Political Plausibility of Medicare for All appeared first on electronichealthreporter.com.

Medicare 89

Medicare Medicare 89

Health Populi

JUNE 5, 2022

In 2006 the Medicare Part D program was implemented, covering older Americans for prescription drugs for the first time. Medicare further drove expansion of generic drug utilization, with co-pays for generics lower for Medicare enrollees than branded drugs. While these four actions to lower drug costs garner over 80% of U.S.

Overpayments 154

Overpayments Overpayment Medicare Medicare 154

Healthcare It News

JUNE 13, 2023

Uber Health launched its HIPAA-enabled API and dashboard in 2018 to offer logistics services to population health management programs. The company says that 3,000 healthcare organizations are already using Uber Health for transportation to primary care appointments and accessing critical prescriptions.

Medicaid 272

Medicaid Medicaid HIPAA Medicare 272

Bill of Health

JULY 15, 2022

Cost Per Event Averted in Cancer Trials in the Adjuvant Setting From 2018 to 2022. Potential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. JAMA Netw Open. 2022 Jun 1;5(6):e2216058. JAMA Netw Open.

Public Health 209

Public Health Medicare Medicare Governance 209

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 114

Hospitals Medicare Medicare Medicaid 114

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.

Medicare 148

Medicare Medicare Medicaid Medicaid 148

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 209

Health Insurance Hospitals FDA Medicaid 209

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 Today

JUNE 2, 2024

The latest from Epic Research: Use of DNA stool tests for colon cancer screening has jumped 9x since 2018 , from 3% of all screenings to 31%, while fewer women are using oral antibiotics to treat acne. Also, 55% of practices allow staff more data access than they actually need to do their job.

Medicare 94

Medicare Medicare Hospitals 94

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

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 163

Telemedicine Medicaid Medicaid Hospitals 163

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

Health Populi

APRIL 8, 2019

That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement. The $285K also assumes the couple doesn’t have employer-sponsored retiree health care coverage and qualifies for “Original Medicare” (not Medicare Advantage, for example).

Medicare 108

Medicare Medicare Health Care Reform Nursing Homes 108

HIT Consultant

SEPTEMBER 14, 2023

What You Should Know: – Out-of-network ground ambulance rides accounted for a larger percentage of ground ambulance claim lines 1 than in-network rides from 2018 to 2022. of all ground ambulance claim lines in 2018 compared to 59.4% of all ground ambulance claim lines in 2018 compared to 59.4% percent in 2018 to 30.6

Hospitals 98

Hospitals Medicare Medicare 98

Fierce Healthcare

APRIL 1, 2024

Spending on GLP-1 drugs in Medicare Part D has spiked massively over the past several years, according to a new analysis from KFF.

Medicare 60

Medicare Medicare 60

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

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

HIT Consultant

SEPTEMBER 1, 2021

– The Bold platform is one of five interventions in the Ochsner Connected Stability pilot fall prevention and monitoring programs focused on helping Medicare Advantage members who are at the highest risk for falls. For non-fatal falls alone, $29 billion was paid out by Medicare in 2018 for treatment and care.

Medicare 52

Medicare Medicare Health Outcomes 52

Healthcare IT Today

OCTOBER 16, 2024

For SNFs that utilized the interventional analytics, the data showed a reduction in Medicare spending per beneficiary, a decrease in hospitalizations due to infections acquired during the SNF stay, and an increase in the rate of successful transitions back to home or community settings. As the study highlights, there were approximately 1.7

Nurses 121

Nurses Hospitals Medicare Medicare 121

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

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

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

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

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. Their Silicon Valley programs Elev X!

Records Management 52

Records Management Hospitals Medicare Medicare 52

Health Populi

SEPTEMBER 24, 2019

This mis-alignment relates to three areas of personal health economics: finance related to Health Savings Accounts (HSAs), Medicare, and long-term care (LTC). For Medicare, two-thirds of future retirees wish they understood the health plan better. employees who participated in 401(k) plans in February 2019.

Health Insurance 116

Health Insurance Medicare Medicare Hospitals 116

Health Populi

SEPTEMBER 20, 2021

physicians worked in a practice that used telehealth versus 25% who did so in 2018, based on a new survey from the AMA. Hy-Vee also introduced a Medicare Aisle into its grocery stores in August 2021. In 2020, 79% of U.S. And the grocer is expanding its pharmacy footprint , having piloted tele-pharmacy back in 2017.

Telemedicine 133

Telemedicine Medicare Medicare Doctors 133

Healthcare IT Today

JULY 12, 2022

For example, the Bipartisan Budget Act of 2018 amended the section on the Social Security Act to expand the types of supplemental benefits that may be offered by Medicare Advantage (MA) plans to chronically ill enrollees.

Medicare 137

Medicare Medicare 137

Innovaare Compliance

APRIL 6, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Bill of Health

JULY 26, 2022

Amazon now has an important foothold in the Medicare market. With significant fanfare, the January 2018 the formation of the health care consortium Haven with Berkshire Hathaway and J.P. Iora Health was acquired by ONEM in September 2021 for approximately $2.1 billion and is an important part of the ONEM story going forward.

US Department of Health and Human Services 174

US Department of Health and Human Services Health Insurance HIPAA Medicare 174

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 109

HIPAA Ransomware Compliance Hospitals 109

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. Mitchell AP, Trivedi NU, Bach PB.

FDA 209

FDA COVID-19 Medicaid Medicaid 209

Healthcare IT Today

DECEMBER 13, 2022

UpStream supports physicians operating under full-risk, value-based arrangements who are providing care to seniors on Medicare with an integrated platform that emphasizes care quality, health equity and total cost of care. ” “As an early investor, we’ve been thrilled with UpStream’s progress.

Medicare 107

Medicare Medicare Nurses 107

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

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] FOOTNOTES. [1]

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

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

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