Healthcare Law Blog

AUGUST 25, 2023

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.

Overpayments 52

Overpayments Overpayment Medicaid Medicaid 52

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

HIT Consultant

JANUARY 16, 2023

We went from sky high growth to the sky is falling, and in 2023 I think this market correction movement will continue forward. As a result, big tech will not make traction against improving the systemic issues that plague the healthcare system in 2023. Jon Bloom, MD, CEO and Co-founder of Podimetrics.

Nurses 98

Nurses FDA Overpayments Overpayment 98

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. billion between 2023 and 2032 from MAOs based on both non-extrapolated and extrapolated overpayment amounts.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

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.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

HIT Consultant

JUNE 15, 2023

The 2023 annual report, titled “Mission Critical: Bringing drug discount stakeholders together so patients win,” outlines Kalderos’ vision for a new paradigm of cooperation among drug discount program stakeholders in which everyone benefits — particularly patients.

Overpayments 98

Overpayments Overpayment Medicaid Medicaid 98

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

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

HIT Consultant

SEPTEMBER 27, 2024

The January 2023 rule from CMS, which struck the fee-for-service adjuster from risk adjustment data validation (RADV) audits, has also increased concern among Medicare Advantage (MA) plans. billion in overpayments to MA plans with this new audit methodology over the next ten years. In one recent audit, OIG found at least $3.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Hall Render

JANUARY 10, 2025

Background CMSs 60-Day Rule is a regulation under the Affordable Care Act (“ACA”) that requires health care providers and suppliers to report and return identified Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply can result in liability under the FCA. The rule is codified at 42 U.S.C.

Overpayments 40

Overpayments Overpayment ACA Medicare 40

Healthcare Law Blog

FEBRUARY 3, 2023

1] Although the regulations were adopted on December 28, 2022, and became effective immediately, OMIG announced in the Compliance Program Guidance that required providers will have until March 28, 2023 , to adopt and implement the necessary changes to their compliance programs.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

Health Care Law Brief

APRIL 12, 2023

The Final Rule is effective June 5, 2023. Notable Omissions from Proposed Rule CMS declined to adopt previously proposed amendments to the standard for “identified overpayments” under Medicare Parts A, B, C, and D. 79452 (2022)). 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. See 42 U.S.C.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Law Advisor

AUGUST 25, 2023

The regulations were finalized in December 2022, with an effective date of March 28, 2023, and an enforcement moratorium that has just ended. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. The final regulations, codified at 18 N.Y.C.R.R.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 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. 15, 2023) ( MedPAC Report ).

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. COVID-19 Blanket Stark Waivers Continue (for now).

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

Health Care Law Brief

MAY 11, 2022

As part of the Fiscal Year 2023 New York state Executive Budget legislation , $1.2 Inappropriately paid claims shall constitute overpayments as defined in the Medicaid regulations and may be recovered accordingly from the employer without recoupment from, or penalty to, any covered worker.

Medicaid 97

Medicaid Medicaid Overpayments Overpayment 97

HIT Consultant

MARCH 20, 2024

billion from 2023 through 2032, including extrapolation effects. The HHS Office of Inspector General (OIG) recently reported that, from October 2014 through December 2016 , 153 audit reports were issued containing 193 overpayment recoveries totaling $648 million, largely due to errors in medical documentation. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Hall Render

AUGUST 4, 2023

CMS described the increase as a “parity adjustment recalibration,” noting that it had previously overestimated overpayments to nursing homes, which resulted in an unintended reduction in reimbursement in 2023. CMS issued a final rule that will increase payments to SNFs by 4%, or $1.4B, starting in 2024.

Hospitals 40

Hospitals Overpayments Overpayment Nursing Homes 40

The Health Law Firm Blog

SEPTEMBER 20, 2023

On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D., 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.

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

AUGUST 24, 2023

On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D., 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.

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

JULY 19, 2023

On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D., 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.

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

JUNE 27, 2023

On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D., 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.

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

MAY 16, 2023

On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D., 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.

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

Innovaare Compliance

MARCH 24, 2024

2023, March) [link] The post Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare appeared first on Inovaare. Retrieved from [link] American Medical Association. 2021, April). 2020 AMA Prior Authorization (PA) Physician Survey. Retrieved from [link] Centers for Medicare & Medicaid Services.

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

Hall Render

APRIL 18, 2022

in fiscal year 2023. reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare. The Public Health Emergency has been in effect since January 27, 2020. CMS plans to increase Medicare reimbursement for SNFs by 3.9% The increase will be reduced by a 4.6%

Public Health 40

Public Health COVID-19 Overpayments Overpayment 40

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. This information was published due to the end of the COVID-19 Public Health Emergency (PHE) which began May 12, 2023.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

Innovaare Compliance

MARCH 24, 2024

Retrieved from [link] American Medical Association. 2021, April). 2020 AMA Prior Authorization (PA) Physician Survey. Retrieved from [link] Centers for Medicare & Medicaid Services. CY (Contract Year) 2024 Physician Fee Schedule Final Rule.

Fraud 52

Fraud Compliance Health Insurance Medicaid 52

Health Law RX

JANUARY 30, 2024

On October 4, 2023, Deputy Attorney General Lisa Monaco announced a new Department of Justice (DOJ) safe harbor policy (the DOJ Announcement ), which incentivizes voluntary self-disclosures by acquiring companies during or immediately after mergers and acquisitions (the M&A Safe Harbor). Ensure Ongoing Compliance.

Compliance 52

Compliance Due Diligence Fraud Governance 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. 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

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

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”). The following table shows the episodic rate calculation for 2023: CY 2022 National Standardized 30-Day Period Payment.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Hall Render

DECEMBER 11, 2024

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.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Redox

APRIL 29, 2019

Rock Health reports that almost $8 billion was invested into digital health start-ups in the last year alone and MarketWatch estimates that the health IT industry will climb to $120 billion by 2023. There is a potential to make real, tangible change and healthcare might finally be ready for it.

Doctors 40

Doctors Overpayments Overpayment Health Insurance 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

FEBRUARY 23, 2024

Vincent’s East Freestanding Emergency Department opens in Trussville Bham health care provider expands Western footprint Cardiologists talk trends in Alabama, Birmingham Mountain Brook concierge service bringing urgent care to the home ALASKA Dr. .:

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Healthcare Law Blog

JANUARY 5, 2023

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.

Medicare 52

Medicare Medicare Medicaid Medicaid 52