Remove Fraud Remove Nurses Remove Overpayments
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Retrieving Billions in Overpayments by CMS

Healthcare IT Today

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).

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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

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, [.]

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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

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, [.].

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OIG Issues Highly Anticipated Industry Segment-Specific Compliance Program Guidance for Nursing Facilities

Hall Render

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.

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2024 Final Rule: CMS Announces More Changes to Medicare Advantage but Declines to Reform the “60 Day Rule”

Health Care Law Brief

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.

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SNF Billing Compliance Made Simple

Medisys Compliance

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.

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Post-Acute Compliance Program Update: OIG Proposes Amendments to Exclusion Rules

Hall Render

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.