Article Medicaid Overpayment 
Healthcare IT Today
FEBRUARY 17, 2023
government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. public in overpayments.
Compliancy Group
FEBRUARY 12, 2025
This article provides an in-depth overview of the key compliance risk areas and recommendations outlined in the ICPG, emphasizing the importance of a proactive approach to compliance and quality assurance. The ICPG was issued after creating the GCPC , a general compliance reference guide for healthcare stakeholders.
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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.
Hall Render
FEBRUARY 14, 2023
billion in overpayments from MAOs for payment years 2011 through 2017. 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.
Health Care Law Brief
MAY 11, 2022
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. Bonus amounts will be commensurate with the number of hours worked by covered workers during designated vesting periods up to a total of $3,000 per covered worker.
Hall Render
JANUARY 10, 2025
On January 1, 2025, the Centers for Medicare and Medicaid Services’ (“CMS”) new 60-Day Rule became effective. However, under the updated rule, the obligation to report and return an overpayment begins upon identification, even if the exact amount is undetermined. The rule is codified at 42 U.S.C. 1320a-7k(d).
AIHC
FEBRUARY 17, 2025
This article follows a road less-traveled by discussing the potential of audit managers knowingly skewing audit results causing unintended consequences within what appears to be a well-functioning compliance program. Tons of information can be found on the Internet, books, articles, etc. on fraud detection and prevention in healthcare.
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