HIT Consultant

SEPTEMBER 27, 2024

Increasingly rigorous oversight from the Centers for Medicare & Medicaid Services (CMS) and Office of the Inspector General (OIG) are calling for better diligence, planning and administrative oversight for effective risk adjustment. billion in overpayments to MA plans with this new audit methodology over the next ten years.

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Innovaare Compliance

MARCH 1, 2022

in 2021 to $170.00 1] The Centers for Medicare & Medicaid Services (CMS) has to establish an annual Part B premium that will adequately fund projected Medicare spending and maintain an adequate reserve in case actual costs are higher than estimated. annually on average between 2021 and 2029 compared to 4.4%

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Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol.

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Healthcare IT Today

FEBRUARY 2, 2023

These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS). In the most recent audit , the organization looked at more than 15,000 beneficiaries in the payment year 2021.

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Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 13, 2021, reissued Nov. 1, 2021), cert. We note that the MA Risk Score is also subject to the Phase In.

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Medicare Medicare Overpayments Overpayment 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. 2021, January 15). 2021, April). Retrieved from [link] Centers for Medicare & Medicaid Services.

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Hall Render

DECEMBER 27, 2023

Further, entities should review non-monetary compensation provided in 2023 to ensure that such compensation did not exceed the 2023 limit of $489 and take any necessary corrective action to repay excess amounts within 180 days of the overpayment or by December 31, 2023.

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Hospitals Overpayment Overpayments Medicaid 75

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. 2021, January 15). 2021, April). Retrieved from [link] Centers for Medicare & Medicaid Services.

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Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

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The Health Law Firm Blog

JUNE 10, 2023

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 By George F. Indest III, J.D., million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. The doctor argued that the [.]

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The Health Law Firm Blog

MARCH 16, 2022

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 By George F. Indest III, J.D., million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. The doctor argued that the.

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Fraud Medicare Medicare Doctors 52

The Health Law Firm Blog

FEBRUARY 10, 2023

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] By George F. Indest III, J.D.,

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Fraud Health Insurance Overpayment Overpayments 52

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. More specifically, the decision to exclude a FFS Adjuster rests largely on the D.C. Circuit’s reasoning in UnitedHealthcare v.

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Medicare Medicare Overpayment Overpayments 52

The Health Law Firm Blog

MAY 6, 2024

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] By George F. Indest III, J.D.,

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Fraud Health Insurance Overpayment Overpayments 40

The Health Law Firm Blog

APRIL 21, 2023

Board Certified by The Florida Bar in Health Law On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees. By George F. Indest III, J.D., Accused in an indictment in [.]

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Overpayment Overpayments Fraud Medicaid 40

The Health Law Firm Blog

JANUARY 24, 2022

Board Certified by The Florida Bar in Health Law On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees. By George F. Indest III, J.D., Accused in an indictment in.

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Overpayment Overpayments Fraud Medicaid 40

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS’s data shows a downward trend in utilization in 2020 but then an increase in utilization in 2021. Discipline.

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Hall Render

DECEMBER 6, 2022

As part of the final regulations released by the Centers for Medicare & Medicaid Services (“CMS”) effective January 19, 2021, CMS finalized a new exception for arrangements where an entity pays a physician less than $5,000 over the course of a calendar year in exchange for items or services. New Exception for Limited Remuneration.

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COVID-19 Hospitals Overpayment Overpayments 40

HIPAA Journal

MARCH 30, 2022

In 2021, 97 non qui tam cases were investigated and $3.59 The total recovered in 2021 exceeded $5 billion. However, the biggest health care initiative of the second Clinton presidency was the Children´s Health Insurance Program (CHIP) which provided health care benefits for children of working families who do not qualify for Medicaid.

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Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). We’ve summarized some of the key changes in the Proposed Rule. Comments on due February 13, 2023. Star Ratings.

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Medicare Medicare Medicaid Medicaid 52

Hall Render

APRIL 26, 2024

million Medicaid enrollees in 12 months; one month left in ‘unwinding’ University of Maryland Medical Center physicians unionize, a first in the state Emergency room wait times are worse than bad. in 256-Slice CT scanner Lifepoint reports $200M+ economic impact in Cen Ky St. health dept. processed 1.5 health dept. processed 1.5

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Nursing Homes US Department of Health and Human Services Nurses Medicaid 40

Hall Render

AUGUST 26, 2022

CMS bulletin presses states on Medicaid nursing home spending. CMS proposes mandatory Medicaid, CHIP quality reporting. Tie nursing home Medicaid payments to care quality, CMS tells states. Alaska’s COVID ‘superstorm’ experience of 2021 offers lessons for future pandemics, study says. Medicaid Contract Remains in Limbo.

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Kaiser Health News

JUNE 29, 2022

They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions in suspected overpayments to the health plans, which are run mostly by private insurance companies.

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