Center for Health Insurance Reform

APRIL 29, 2022

As many as 16 million people are expected to lose Medicaid once the COVID-19 public health emergency ends. In their latest To the Point blog for the Commonwealth Fund, Sabrina Corlette and Maanasa Kona discuss strategies that marketplaces can deploy to help reduce the potential coverage loss and help consumers make a smooth transition.

Public Health 96

Public Health ACA COVID-19 Health Insurance 96

MRO Compliance

NOVEMBER 21, 2024

The Centers for Medicare & Medicaid Services (CMS) 2025 Physician Fee Schedule (PFS) Final Rule brings notable updates to the Quality Payment Program (QPP), which will impact eligible clinicians, groups, virtual groups, subgroups, and APM entities.

Compliance 147

Compliance Medicare Medicare Medicaid 147

Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). for every $1 spent How ProviderTrust Can Help With nearly 80 million individuals covered by Medicaid, every data point counts.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Bill of Health

NOVEMBER 15, 2023

See e.g., California’s 1115 waiver (pages 1-9 have an overview of prerelease services). “If… w e can reform jails and prisons from places of withdrawal and abstinence to treatment and recovery, we need to better connect their populations with the outside world.

Governance 173

Governance Public Health Telemedicine COVID-19 173

MRO Compliance

AUGUST 3, 2022

This blog post serves as a summary to increase efficiency and security in the audit process. Consider auditing software that can instantly transmit charts, discussions, and appeal filings to Medicare, Medicaid and commercial auditors, preventing file loss and delivery delay. Audit Software Helps You Work Smarter, Not Harder.

Compliance Officers 130

Compliance Officers Medicare Medicare Compliance 130

The Health Law Firm Blog

JANUARY 12, 2024

Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. By George F. Indest III, J.D., The deal was signed on July 11, 2022, but wasn’t publicly [.]

Medicaid 52

Medicaid Medicaid Overpayment Overpayments 52

Healthcare Law Blog

FEBRUARY 12, 2024

CMS approved $500 million in infrastructure spending for NYS to establish social care networks (“ SCNs ”) to provide HRSN screening and referral services to Medicaid beneficiaries that are targeted populations for HRSN services. Medicaid Hospital Global Budget Initiative CMS authorized up to $2.2

Medicaid 52

Medicaid Medicaid Hospitals Nurses 52

The Health Law Firm Blog

MAY 21, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

Medicaid 52

Medicaid Medicaid Fraud Medicare 52

MRO Compliance

JANUARY 16, 2025

To address these gaps, the Centers for Medicare & Medicaid Services (CMS) now mandates the use of FHIR-based APIs for data sharing. Product Marketing Manager at MRO, contributed to the above blog post. Ready to explore how MROs modern solutions can support your organizations growth? Visit our website to learn more.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

The Health Law Firm Blog

APRIL 23, 2024

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By Carole C. Schriefer, J.D. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according to the U.S. Attorney’s Office for Washington, D.C. She was indicted in [.]

Medicaid 52

Medicaid Medicaid Fraud Medicare 52

The Health Law Firm Blog

MARCH 26, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

Medicaid 52

Medicaid Medicaid Fraud Medicare 52

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

The Health Law Firm Blog

MAY 7, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

Medicaid 52

Medicaid Medicaid Fraud Medicare 52

Healthcare Law Blog

JANUARY 31, 2023

This blog is the second installment of our Digital Health Trends series. vii] “Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule,” Centers for Medicare & Medicaid Services (Nov.

COVID-19 105

COVID-19 Medicare Medicare Medicaid 105

Healthcare Law Blog

OCTOBER 27, 2022

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program. FOOTNOTES. [1]

Nursing Homes 96

Nursing Homes Medicaid Medicaid Nurses 96

McBrayer Law Blog

FEBRUARY 23, 2022

More > Tags: Audit , Centers for Medicare & Medicaid Services , CMS , COVID-19 , Healthcare Compliance Issues , Medicaid , Medicare , regulatory compliance. Just as the pandemic may finally be easing, federal focus on use of COVID-19 resources promises to increase healthcare providers’ stress.

COVID-19 97

COVID-19 Compliance Regulatory Compliance Medicaid 97

McBrayer Law Blog

OCTOBER 18, 2021

More > Tags: Centers for Medicare & Medicaid Services , Civil Penalties , CMS , Healthcare Providers , Long-Term Care , Long-Term Care Facilities , Medicare. For reference, the 2017 Guidance can be found here. The accompanying CMP Analytic Tool can be found here.)

Nursing Homes 96

Nursing Homes Nurses Medicaid Medicaid 96

Jane Sarashon

JANUARY 19, 2024

Elevance Health, the health plan organization comprising XXX plans serving 117 million members, launched a program to channel mobile phones and data plans into the hands of some Medicaid plan enrollees, explained in the organization’s press release on the program.

Medicaid 76

Medicaid Medicaid COVID-19 Health Outcomes 76

MRO Compliance

FEBRUARY 3, 2025

HEDIS audits are important for Medicare and Medicaid health plans because data is used to determine the efficacy of a payer to care for its members. Utilization and Risk Adjusted Utilization. Health Plan Descriptive Information. Measures Collected Using Electronic Clinical Data Systems.

Patient Satisfaction 147

Patient Satisfaction Compliance Medicare Medicare 147

Center for Health Insurance Reform

MARCH 25, 2024

While state efforts to provide Medicaid-equivalent benefits to some populations of undocumented residents have helped expand access to coverage, many low- and moderate-income undocumented residents remain without affordable health insurance options.

Health Insurance 52

Health Insurance Medicaid Medicaid State Policy 52

Healthcare Blog

FEBRUARY 7, 2023

This blog post will explore the differences between nursing procedures and policy and discuss why both are necessary for healthcare settings. Policies and Procedures – PMC Centers for Medicare & Medicaid Services. Policy, on the other hand, is a statement that guides an organization’s decisions and actions.

Nurses 102

Nurses Hospitals Medicaid Medicaid 102

Bill of Health

SEPTEMBER 25, 2024

The plaintiffs argue that those enrolled in the SSI program at the time of hospitalization qualify, whereas the Department of Health and Human Services (HHS), which oversees the Centers for Medicare and Medicaid Services, argues that only those entitled to receive SSI cash payments qualify.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

MedTrainer

AUGUST 8, 2024

In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Required Training for Medicaid-Enrolled Providers Though this article discusses Medicare-enrolled provider training requirements, I want to discuss how Medicaid enrollment and training differ. and state regulations.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Bill of Health

NOVEMBER 9, 2023

Despite the important enactment in 2010 of the Patient Protection and Affordable Care Act (ACA), which increases access to care by expanding Medicaid eligibility and protecting insurance coverage of people with pre-existing health conditions and disabilities, more than 25 million people remain uninsured.

COVID-19 162

COVID-19 Public Health ACA Health Insurance 162

Hall Render

FEBRUARY 17, 2025

According to a statement released on the Center for Medicare and Medicaid Services (CMS) website, effective February 14, 2025, implementation of the Hospice Special Focus Program for calendar year 2025 has ceased so that CMS may further evaluate the program. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 89

Medicare Medicare Nursing Homes Medicaid 89

McBrayer Law Blog

JANUARY 14, 2022

The Court upheld, however, a similar rule for healthcare employers contracted with the Centers for Medicare and Medicaid Services (“CMS”) as further outlined below.

COVID-19 90

COVID-19 Medicaid Medicaid Medicare 90

The Health Law Firm Blog

MARCH 14, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

The Health Law Firm Blog

FEBRUARY 23, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

Hall Render

JANUARY 29, 2025

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. Hall Render blog posts and articles are intended for informational purposes only.

Fraud 80

Fraud Medicare Medicare Compliance 80

American Medical Compliance

OCTOBER 25, 2024

In this blog, we will explore how healthcare providers can conduct effective compliance audits, ensuring both thoroughness and efficiency. Why Compliance Audits Matter in Healthcare A compliance audit is a critical process that reviews an organization’s adherence to internal policies and external regulations.

Compliance 105

Compliance Fraud HIPAA Compliance Framework 105

The Health Law Firm Blog

FEBRUARY 1, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

MRO Compliance

JUNE 23, 2022

Audit document delivery instantly transmits charts, discussions, and appeal filings to Medicare, Medicaid and commercial auditors, preventing file loss and delivery delay. You can log and track all audits in a single system that simplifies information sharing and collaboration among authorized users. Save time through automation.

Medicaid 130

Medicaid Medicaid Medicare Medicare 130

MRO Compliance

JUNE 1, 2022

This review is part of the Star rating system, which according to RAC Monitor was developed by the Centers for Medicare & Medicaid Services (CMS) to rate health plan performance for Medicare Advantage programs and Medicare risk adjustment initiatives. HEDIS audits are important for Medicare and Medicaid health plans.

Medicare 130

Medicare Medicare Compliance Medicaid 130

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Wyatt Law Blog

FEBRUARY 22, 2024

On February 8, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum entitled Texting of Patient Information and Orders for Hospitals and CAHs (the 2024 Memo), which provides updated guidance to State Survey Agency Directors.

Medicaid 80

Medicaid Medicaid Medicare Medicare 80

Healthcare IT Today

FEBRUARY 25, 2024

The news isn’t all good, as ONC noted in a blog post , as 68% of vendors are also using some form of proprietary APIs as well. Mental health service provider Brightside Health expanded Medicare and Medicaid coverage with payers in more than a dozen states.

Telemedicine 95

Telemedicine Compliance FDA Hospitals 95

Healthcare Law Blog

DECEMBER 1, 2023

HHS-OIG conducted investigations resulting in 661 criminal actions against individuals related to Medicare and Medicaid, as well as 726 civil actions, including false claims, unjust-enrichment lawsuits, and civil monetary penalty settlements. Enhancing program integrity in noninstitutional care settings, such as home health and hospice care.

COVID-19 52

COVID-19 Fraud Telemedicine Medicaid 52