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This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. Challenges of Investigating Overpayments Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]
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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].
Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community.
405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. We note, however, that an MA plan may elect to offer, as a Medicare benefit, coverage for post-hospital skilled nursing facility care without a prior qualifying hospital stay that is required under traditional Medicare. See Proposed Rule at 79559.
Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. SNF billing compliance refers to the adherence to federal and state regulations governing billing processes for skilled nursing facilities.
OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Under 42 CFR Sec. Under 42 CFR Sec.
However, ChristianaCare employees – including hospitalists, residents, physician assistants, and nurse practitioners – worked in the NICU alongside Neonatology Associates, and were also providing care to these same patients. Million To Resolve Health Care Fraud Allegations | United States Department of Justice [3] See Defs. Opening Br.
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 compact does not apply to nurse practitioners (NPs) because they are licensed under state boards of nursing and not medicine.
Fraud, waste, & abuse. Improper payments are not necessarily measures of fraud, but instead are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements. These improper payments may be overpayments or underpayments and do not necessarily represent expenses that should not have occurred.
By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]
By George F. 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. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]
By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]
Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’
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for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M
10 states with the largest decreases to travel nurse pay. How tight nursing home capacity is bottlenecking hospital operations. Judge orders Anthem to face lawsuit over alleged Medicare overpayments. Investigators found high rates of bed sores and extended isolation among Providence nursing home patients, leading to $310K fine.
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? hospital cost review board a bandage for rising costs?
California physician convicted of healthcare fraud, kickbacks California’s healthcare minimum wage boost to cost $4B City Council upholds approval of Hollywood Presbyterian medical offices at 1321 N. Will it survive the next few years? See who got an A.
CMS bulletin presses states on Medicaid nursing home spending. CMS informational bulletin urges steps for improving health outcomes in nursing homes. Tie nursing home Medicaid payments to care quality, CMS tells states. Alabama Baptist universities address nursing shortage. Compliance with Oct. CALIFORNIA. in net income.
NATIONAL 3 things to expect from the pharmaceutical supply chain in 2024 Absence of AI hospital rules worries nurses American Academy of Dermatology votes to keep its diversity policies after anti-DEI proposal Are digital health partnerships replacing M&A? HSHS moves up 2nd hospital closure How Dr.
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
to Endow UA Little Rock Nursing Director Position Arkansas hospital coalition aims to reduce cases of congenital syphilis Mercy Hospital Paris shines as only Arkansas facility on national Top 100 list Vaccination rates are declining. expansion Mayo Clinic to invest nearly $2 billion in Valley hospital campus, hire thousands Mayo plans $1.9B
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Med League Support Services provides medical billing expert witness to review medical billing fraud cases. million fraud scheme against payers and patients. Dr. Rosen was part of this large fraud scheme where physician prescribes expensive drugs through network of pharmacists who then pay bribes to fill the order.
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