HIPAA Journal

SEPTEMBER 29, 2022

The Government Accountability Office (GAO) recently conducted a review of Medicare telehealth services provided during the COVID-19 pandemic, when a waiver was in place that greatly expanded access to telehealth and virtual visits. Between April and December 2019, 5 million Medicare telehealth visits were conducted.

Medicare 77

Medicare Medicare COVID-19 HIPAA 77

Bill of Health

JULY 15, 2022

The selections feature topics ranging from a discussion of potential pathways to enable government patent use before nonpatent exclusivities expire, to an examination of medical oncologists who receive more than $100,000 annually from pharmaceutical companies, to an analysis of the launch prices of new drugs from 2008-2021. JAMA Intern Med.

Public Health 209

Public Health Medicare Medicare Governance 209

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

Medicare 52

Medicare Medicare Overpayments Overpayment 52

HIT Consultant

MARCH 18, 2022

What You Should Know: – The 32BJ Health Fund, a self-insured fund that provides care for 32BJ SEIU members and their dependents, today released a report that lays bare the stark price disparities between Medicare and private hospitals, and outlines solutions to both reins in prices and holds hospital systems accountable for these practices.

Governance 52

Governance Hospitals Medicare Medicare 52

Healthcare Law Today

DECEMBER 15, 2022

The case asks whether the government has authority to dismiss an FCA suit after initially declining to proceed with the action, and if so, what standard would apply. Petitioner-Relator Polansky is a doctor and former consultant for Executive Health Resources (EHR), a company that submits claims to Medicare on behalf of health care providers.

Governance 52

Governance Doctors Medicare Medicare 52

Health Populi

OCTOBER 17, 2019

In 2019, it appears that patients have backslid, according to the 2019 Healthcare Consumerism Index from Alegeus. adults in September 2019 on issues concerning health care costs, shopping, value, saving and spending. The first chart shows that the 2019 Index fell from 60.1 points in 2018 to 57.9 households.

Health Insurance 61

Health Insurance Medicare Medicare Governance 61

Bill of Health

JUNE 26, 2023

have debated whether the government should produce drugs and biologics. Ultimately, the industry was successful in keeping the government away from biologics manufacturing by agreeing to abide by government regulations. By Aparajita Lath For over 100 years, policy makers and pharmaceutical manufacturers in the U.S.

Pharmaceutical Industry 196

Pharmaceutical Industry Governance FDA Public Health 196

Healthcare IT News - Telehealth

JULY 25, 2024

In an update, MediSecure said affected individuals included those who used its service between March 2019 and November 2023. Individual healthcare identifiers, Medicare card numbers, and prescription medications and instructions are some types of information that were exposed in the hack, it added.

Governance 118

Governance Ransomware Medicare Medicare 118

Healthcare IT News - Telehealth

FEBRUARY 22, 2021

Among the allegations are that Wolfe and her conspirators submitted well over $400 million in illegal durable medical equipment claims to Medicare and the Civilian Health and Medical Program of the Department of Veterans, relying on the guise of "telemedicine" to explain the unusually high volume of claims.

Fraud 192

Fraud Telemedicine US Department of Health and Human Services Medicare 192

Health Law RX

AUGUST 10, 2023

et al , the government contends that Teva funded the copays of Medicare patients using Copaxone, a multiple sclerosis drug, through donations to nonprofits running patient assistance programs. Teva in turn allegedly benefited from these donations by increasing the cost of Copaxone to the government. The court disagreed.

Governance 52

Governance Medicare Medicare Fraud 52

HIT Consultant

AUGUST 8, 2022

It also offers in-home health evaluations for Medicare Advantage and other government-run managed-care plans. In July, the company said it planned to wind down one of its units after changes to a government-payment model and focus on more-profitable businesses. B in 2019. Signify went public in February 2021.

Governance 97

Governance Medicare Medicare Health Insurance 97

Healthcare It News

JULY 11, 2024

Hoping payers will 'step up' On the payer side, ONC said it worked closely with the Centers for Medicare and Medicaid Services in creating voluntary certification requirements, for "greater assuredness that systems that go through that certification process will actually be able to interoperate with the provider organizations.

US Department of Health and Human Services 216

US Department of Health and Human Services Public Health COVID-19 Governance 216

Healthcare Compliance Blog

MAY 19, 2022

million to settle allegations that it violated the False Claims Act by submitting false claims to Medicare. The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, the hospital submitted claims to Medicare for Intensive Cardiac Rehabilitation (ICR) services provided to Medicare beneficiaries.?Before

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

Mobi Health News

APRIL 17, 2019

Healthcare professionals believing that the Apple Watch is going to be a clinically useful tool edged out those seeing it as a consumer fad — but just barely in the new 2019 Venrock Healthcare Prognosis report.

Medicare 68

Medicare Medicare Governance 68

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. Food and Drug Administration (FDA) prior to distribution.

FDA 59

FDA Governance Medicare Medicare 59

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 Managed care now covers more than half of Medicare enrollees and over 80% of Medicaid enrollees.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

YouCompli

AUGUST 29, 2023

Health and Human Services Office of Inspector General (OIG) found that Medicare beneficiaries used 88 times more telehealth services during the first year of the pandemic than they did the previous year. million in Medicare fee-for-service payments. million in Medicare fee-for-service payments. It involved an estimated $1.2

Fraud 52

Fraud COVID-19 Medicare Medicare 52

AIHC

NOVEMBER 15, 2022

Noncompliance with the Hospital Price Transparency Rule The Hospital Price Transparency Final Rule (“the final rule”) was published in November 2019 and went into effect on January 2021. The government expects hospitals to be compliant as there has been ample time to prepare for its implementation and to comply with the requirements.

Hospitals 52

Hospitals US Department of Health and Human Services Compliance Governance 52

Healthcare Compliance Blog

APRIL 12, 2022

By pleading guilty, the business owner admitted that she willfully failed to deposit the Federal Insurance Contributions Act and Medicare (FICA) taxes and income taxes that were withheld from her employees’ wages. However, instead of forwarding those taxes to the government, she kept them for her business.

Medical Billing 59

Medical Billing Fraud Governance Medicare 59

HIPAA Journal

JUNE 9, 2023

In 2019, David Dubin was sentenced to one year in jail for submitting inflated bills and 2 years for aggravated identity theft, with the sentences to run consecutively. Dubin’s legal team appealed but the U.S. Under the letter of the law, small-scale fraud and large-scale fraud carry the same sentence for aggravated identity theft.

Fraud 107

Fraud Medicaid Medicaid Doctors 107

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

HIT Consultant

JULY 24, 2024

The company’s AI practices are guided by standards from the Centers for Medicare & Medicaid Services (CMS) and the National Institutes of Standards and Technology (NIST). This commitment follows the launch of Talkspace’s AI suicide risk alert system, which has flagged 32,000 members showing signs of suicidality or self-harm since 2019.

Regulatory Compliance 52

Regulatory Compliance Compliance Officers Compliance Medicaid 52

Health Care Law Brief

DECEMBER 7, 2021

In a November 12, 2021 revision of its prior draft guidelines for hospital co-location compliance with Medicare conditions of participation (COP) for hospitals (QSO-19-13), CMS has apparently softened its approach to co-location.

Compliance 40

Compliance Hospitals Medicare Medicare 40

Health Care Law Brief

JULY 19, 2023

Executive Health Resources affirmed the federal government’s power to dismiss a False Claims Act (“FCA”) action brought under the qui tam provisions whenever it chooses to intervene. Jesse Polansky) filed a qui tam action against Executive Health Resources for allegedly submitting fraudulent claims to the Medicare program.

Governance 52

Governance Medicare Medicare Fraud 52

YouCompli

JULY 26, 2023

Health and Human Services Office of Inspector General (OIG) found that Medicare beneficiaries used 88 times more telehealth services during the first year of the pandemic than they did the previous year. million in Medicare fee-for-service payments. billion in Medicare funds for orthotic braces in the 20 months that followed. 

Fraud 52

Fraud Compliance COVID-19 Medicare 52

Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. On April 7, 2022, a civil complaint was filed against the two men, which alleges that they conspired to violate the False Claims Act by submitting false and fraudulent claims to Medicare for medically unnecessary hospice and home health services.

Fraud 59

Fraud Medicare Medicare Compliance 59

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

Medicare 52

Medicare Medicare Compliance Governance 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. Background. for 340B eligible hospitals.

Medicare 45

Medicare Medicare Hospitals Governance 45

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

Fraud 63

Fraud Medicare Medicare Overpayments 63

Hall Render

OCTOBER 1, 2024

Case Background In 2019, the relator filed a lawsuit against her former employer and other defendants, claiming violations of the FCA from the defendants’ alleged misrepresentations of patients’ medical conditions to Medicare. Florida Medical Associates, LLC et al.

Compliance 40

Compliance Governance Medicare Medicare 40

Health Populi

AUGUST 16, 2019

Employers cited several main tactics to address coupon cards looking forward from 2019 to 2022. One-third of employers were already doing this in 2019, with another 20% adding in 2020 and 16% considering for 2021-22. Federal government Blueprint for reducing prescription drug costs. Across party identification, U.S.

Governance 79

Governance Health Care Reform FDA ACA 79

Health Populi

OCTOBER 28, 2019

Rising health care costs continue to concern most Americans, with one in two people believing they’re one sickness away from getting into financial trouble, according to the 2019 Survey of America’s Patients conducted for The Physicians Foundation. This year’s poll was conducted in September 2019 and included input from 2,001 U.S.

Single Payer Health Care 54

Single Payer Health Care Medical Billing Health Care Reform Governance 54

The Health Law Firm

MARCH 27, 2019

Board Certified by The Florida Bar in Health Law On February 5, 2019, two Lake County, Florida, ophthalmologists agreed to a six-figure payment for improperly billing Medicare for eyelid repair surgeries, the US Attorney’s Office announced. By George F. Indest III, J.D., Improper Billing Procedures.

Doctors 40

Doctors Medicare Medicare Governance 40

HIT Consultant

DECEMBER 26, 2022

Prior to COVID-19 , the volume of diagnostic imaging examinations had been growing annually by >3% and hit 5.0bn in 2019. Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology, and telehealth.

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Healthcare IT Today

SEPTEMBER 21, 2022

For example telehealth utilization increased 63x (in Medicare alone!) between the beginning of 2019 and the end of 2020. Additionally, an Assistant Secretary for Planning and Evaluation report found that Medicare visits conducted through telehealth skyrocketed from approximately 840,000 in 2019 to 52.7

Fraud 71

Fraud COVID-19 Medicare Medicare 71

HIT Consultant

AUGUST 15, 2022

Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. Due to rapid growth of the 65-and-older portion of the population, Medicare expenditures are forecast to reach $1,559.4 – Continued increase in overall Medicare costs. Case in Point.

Medicare 52

Medicare Medicare Medicaid Medicaid 52