Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

Hall Render

DECEMBER 27, 2023

The $5,000 limit is adjusted annually for inflation and will increase from the 2023 limit of $5,702 to $5,913 beginning January 1, 2024, for the 2024 calendar year. The post Non-Monetary Compensation to Physicians: New Limits for 2024 and Chance to Review 2023 appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.

Hospitals 75

Hospitals Overpayments Overpayment Medicaid 75

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs. Background RADV audits are the main tool that CMS uses to correct overpayments made to MAOs.

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Overpayments Overpayment Medicare Medicare 40

The Health Law Firm Blog

SEPTEMBER 20, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

AUGUST 24, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

JULY 19, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

JUNE 27, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

MAY 16, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

Health Care Law Brief

MAY 11, 2022

As part of the Fiscal Year 2023 New York state Executive Budget legislation , $1.2 No bonus amount may be paid to any worker who has been suspended or excluded under the Medicaid program during the vesting period and at the time an employer submits a claim. Covered Employers. Covered Employer Tracking and Recordkeeping.

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Medicaid Medicaid Overpayments Overpayment 97

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. As for the final judgment award, on March 17, 2023, the U.S.

Overpayments 52

Overpayments Overpayment Fraud Governance 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. The regulations were finalized in December 2022, with an effective date of March 28, 2023, and an enforcement moratorium that has just ended. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

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.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The Final Rule is effective June 5, 2023. Parts 417, 422, 423, 455, and 460. 79452 (2022)). See Proposed Rule at 79559.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

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 ). See March 2023 Report to the Congress: Medicare Payment Policy, MedPAC at 332 (Mar. See 88 Fed. 6643 (Feb.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

DECEMBER 6, 2022

non-cash or cash equivalent) compensation to physicians up to an aggregate amount of $489 for calendar year 2023. The $5,000 limit is adjusted annually for inflation and will increase from the 2022 limit of $5,270 to $5,702 beginning January 1, 2023 for the 2023 calendar year. New Exception for Limited Remuneration.

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 billion from 2023 through 2032, including extrapolation effects. million (net) and $4.7 Now is a critical moment for Medicare Advantage Organizations (MAOs) and risk-bearing providers to prepare.

Overpayments 52

Overpayments Overpayment Medicare Medicare 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. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements. 2021, January 15).

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Fraud Health Insurance Medicaid Medicaid 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. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements. 2021, January 15).

Fraud 52

Fraud Compliance Health Insurance Medicaid 52

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

Hall Render

DECEMBER 11, 2024

The Proposed Rule would codify changes made by the Medicaid Services Investment and Accountability Act of 2019 (MSIAA), that added exclusion authorities related to misclassification and false information about outpatient drugs. Information about the LEIE may be found on the OIGs Exclusions page.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Hall Render

NOVEMBER 25, 2024

Nursing Facility ICPG, together with OIG’s General Compliance Program Guidance (“GCPG”) issued in November 2023, serve as OIG’s updated and centralized source of voluntary compliance program guidance for nursing facilities. It is intended only to assist nursing facilities in evaluating and mitigating their own particular risk areas.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

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. Challenge in Court On September 1, 2023, Humana Inc. and its subsidiary Humana Benefit Plan of Texas, Inc.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

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”). CY 2023 HH Payment Update. CY 2023 National, Standardized 30-Day Period Payment. 1,904.76.

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COVID-19 Payment Systems Medicare Medicare 40

C&M Health Law

DECEMBER 18, 2023

Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. OIG explains that implementing quality and safety considerations into a compliance program can help to prevent excessive or medically unnecessary services that can lead to overpayments.

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Mary’s unveils new name, but mission remains unchanged UCHealth sues thousands of patients every year. What they say sets them apart.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

MAY 10, 2024

Vincent Parkview Health’s ASC strategy: 2 updates Indiana hospital margins lag behind nation, with some budgets in the red Report shows Indiana hospitals lost more than $700 million in income in 2023 Two Indiana Hospitals Receive a “D” in Patient Safety Franciscan Health to partner with nonprofits Beacon Health System receives $5.4M

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

JUNE 30, 2023

in false claims Georgia ranked as one of the worst states for children’s health in 2023 Georgia’s maternal mortality rate still one of the highest in U.S., Here’s what you need to know. Georgia physician found liable for $1.1M

US Department of Health and Human Services 40

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

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

Nursing Homes 40

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

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”). Comments on due February 13, 2023. We’ve summarized some of the key changes in the Proposed Rule. Star Ratings.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M Can lawmakers do anything about it?

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

OCTOBER 7, 2022

Judge orders Anthem to face lawsuit over alleged Medicare overpayments. New Mexico seeking payer contracts for 1M Medicaid recipients. URMC CEO to retire in 2023. Medicaid expansion in sight for North Carolina. North Texas health care leaders share how pending federal policy changes will impact Medicaid services.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

JANUARY 19, 2024

Workers at another D.C. Bipartisan Ky. hospital company Kansas City Orthopaedic Institute appoints new CEO Kansas City University’s new research center aims to answer: ‘How do we keep people well?’ Bipartisan Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

NOVEMBER 10, 2023

NATIONAL 340B repayments welcomed but concern remains, hospital group says 4 pieces of legislation fighting to alleviate the physician shortage crisis AHA Files Lawsuit Challenging HHS Guidance on Tracking Technologies AHA says 3.1%

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 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. Medicaid Contract Remains in Limbo. ‘Not on the same page’: No deal yet on NC Medicaid expansion. NORTH DAKOTA.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

MARCH 22, 2024

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

Nursing Homes 40

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

Hall Render

MARCH 15, 2024

of Labor projects 6000 health care job openings per year Negotiations between Local 17 Nurses and Providence St. Patrick Hospital to take place at later date St.

US Department of Health and Human Services 40

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