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 248

US Department of Health and Human Services Public Health COVID-19 Governance 248

Healthcare It News

MARCH 18, 2022

Before COVID-19, a few companies, such as Livongo, made a splash in the digital health community by going public – Livongo in July 2019. Fortunately, government, investors and startups are working together to close some of these care gaps.

Medicaid 358

Medicaid Medicaid COVID-19 Telemedicine 358

Healthicity

OCTOBER 16, 2023

Medicare Advantage Compliance Under the Spotlight: Lessons from Cigna's $172 Million Settlement $172 million is a lot of money. It's also the amount that the Cigna Group recently agreed to pay to resolve allegations it violated the False Claims Act in relation to its Medicare Advantage (MA) plan enrollees. government joined the action.

Medicare 52

Medicare Medicare Governance Compliance 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

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 127

Governance Ransomware Medicare Medicare 127

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

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 Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-417836, 2020 CPD ¶ 47 ( Nov.

Governance 52

Governance Department of Veterans Affairs Medicaid Medicaid 52

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

Health Populi

JULY 16, 2020

2019-nCoV acute respiratory disease; and, B97.29, other coronavirus as the cause of disease classified elsewhere which was the original code used until March 18, 2020, when the specific coronavirus code was implemented. They used two ICD-10-CM diagnostic codes for this research: U07.1,

COVID-19 148

COVID-19 Hospitals Health Insurance Medicare 148

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

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

Hall Render

JUNE 8, 2023

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

Medicare 40

Medicare Medicare Hospitals Governance 40

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 IT Today

OCTOBER 19, 2022

Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy.

Medicaid 119

Medicaid Medicaid COVID-19 Telemedicine 119

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

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

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

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

Jane Sarashon

DECEMBER 18, 2024

But today we report out the latest data from the Centers for Medicare and Medicaid Services (CMS) that national health spending in America reached $4.9 The rate of spending among the three other payer types – Medicare, Medicaid, and consumers’ out-of-pocket costs — grew more modestly, at 8.1%, 7.9%, and 7.2%

Medicare 52

Medicare Medicare Health Insurance COVID-19 52

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

HIT Consultant

NOVEMBER 29, 2022

Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy.

Medicaid 98

Medicaid Medicaid Telemedicine Governance 98

Healthcare IT News - Telehealth

FEBRUARY 5, 2024

When telepsychiatry was first in higher demand due to COVID, it is estimated in February 2019, 4% of survey respondents indicated using telehealth services. You say payers and patients will more greatly embrace telepsychiatry as a form of healthcare delivery. What does this mean for mental healthcare this year?

COVID-19 161

COVID-19 Public Health Licensing Telemedicine 161

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

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 72

Fraud Medicare Medicare Overpayments 72

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

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

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

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 61

Fraud COVID-19 Medicare Medicare 61

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

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

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

Health Populi

MARCH 26, 2020

2019-28: Expected Rebound in Prices Drives Rising Spending Growth. ” These factors come out of the 2019 Medicare Trustees Report and include but aren’t limited to tax policy, the state of insurance marketplaces, and employer-sponsored health insurance assumptions. NHE will grow 5.4% in the decade, the model expects.

COVID-19 77

COVID-19 Health Insurance Public Health Medical Billing 77

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

Kaiser Health News

MAY 27, 2022

A 2019 study found patients with inflammatory bowel diseases, including Crohn’s disease, incur about $23,000 in health care costs a year. For those 65 and older, Medicare picks up the tab. Medication treatments alone can cost tens of thousands of dollars annually.

Doctors 120

Doctors Nursing Homes Nurses Medicare 120

Healthcare IT Today

APRIL 20, 2023

million in 2019 to 28.5 Setting a Higher Bar While the industry has historically been protected by government oversight, Health Gorilla and several other organizations are looking to deepen public-private collaboration by applying to be QHINs. million in 2021 – and 35 percent more patients were impacted in the second half of 2022.

Governance 69

Governance Medicaid Medicaid Medicare 69