Healthcare Dive

SEPTEMBER 16, 2024

The Illinois-based pharmacy giant has agreed to pay almost $107 million to settle claims it billed Medicare, Medicaid and other government programs for prescriptions that were never dispensed.

Medicaid 301

Medicaid Medicaid Medicare Medicare 301

Healthcare Dive

APRIL 21, 2025

During a ceremony at the Oval Office, Dr. Mehmet Oz said he would focus on reducing chronic disease, “modernizing” Medicare and Medicaid, and targeting fraud, waste and abuse in government insurance offerings.

Fraud 248

Fraud Medicaid Medicaid Medicare 248

Healthcare Dive

DECEMBER 4, 2023

The HHS’ Office of the Inspector General’s report tallied 707 criminal enforcement actions and 746 civil actions for fraud and misspent funds in programs like Medicare and Medicaid.

Fraud 246

Fraud Governance Medicaid Medicaid 246

Healthcare IT News - Telehealth

JANUARY 11, 2023

The Kaiser Family Foundation recently looked at state trends with regard to expanding access to telehealth-based behavioral care during the pandemic and found that states see telemedicine as a key component of maintaining access to behavioral healthcare for Medicaid enrollees. WHY IT MATTERS. " THE LARGER TREND. ON THE RECORD.

Medicaid 182

Medicaid Medicaid Medicare Medicare 182

HIT Consultant

DECEMBER 20, 2024

By integrating fragmented networks of government programs and insurance benefits, DUOS enhances the continuum of care and delivers an accessible, cohesive user experience. The platform goes beyond health insurance and medical treatments, integrating government programs as part of a holistic healthcare journey.

Governance 59

Governance Health Insurance Medicaid Medicaid 59

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Medicaid 137

Medicaid Medicaid Fraud Hospitals 137

Healthcare Dive

MAY 17, 2023

The findings reflect government subsidies aimed at boosting healthcare access during the pandemic, and requirements that states keep Medicaid beneficiaries on their rolls during the public health emergency.

Medicaid 261

Medicaid Medicaid Public Health Governance 261

Bill of Health

FEBRUARY 6, 2024

State Government Opportunities: States can increase expungement rates by amending laws to apply automatic expungement to minor drug possession convictions and seal the records. States can also remove barriers to local governments setting a livable local minimum wage. Code § 32) by making the tax credit monthly. 34:11-56a et seq.

Governance 305

Governance Public Health Local Policy Medicaid 305

Healthcare IT News - Telehealth

APRIL 6, 2022

Enterprise Taxonomy: Node settings: Exclude from Accelerate RSS feed

Governance 147

Governance Medicaid Medicaid 147

Fierce Healthcare

JULY 12, 2024

Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S. Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S.

Medicaid 119

Medicaid Medicaid Health Insurance Governance 119

MRO Compliance

NOVEMBER 13, 2023

the leading clinical data exchange company in healthcare, announced that Adrienne Morrell has joined the company as its new Vice President of Government Affairs. Morrell brings with her more than 25 years of government affairs experience covering both state and federal rulemaking tied to Medicare, Medicaid, commercial insurance and health IT.

Governance 133

Governance Health Insurance Medicaid Medicaid 133

HIT Consultant

OCTOBER 18, 2023

Chris Oskuie, VP, State & Local Government &Education Sales at Software AG Government Solutions As a result of the Families First Coronavirus Response Act (FFCRA), Medicaid programs were required to keep citizens continuously enrolled through the COVID-19 public health emergency (PHE).

Medicaid 103

Medicaid Medicaid Governance COVID-19 103

HIT Consultant

OCTOBER 10, 2024

Donna Migoni Executive Managing Director, Medicaid Enterprise Services at Maximus More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions. 1) Analyze and prioritize. 4) But don’t forget the data.

Medicaid 105

Medicaid Medicaid Governance Fraud 105

Bill of Health

MARCH 14, 2025

Government Regulation Hims? Approximately 14 states Medicaid programs cover any form of a GLP-1 drug to treat obesity. Related Articles Government Regulation When Clinical Trials Meet Patents: Finding Balance in Law By Erin Lynch Government Regulation Decoding Front-of-Package Food Labels: Are They Really Telling Us Whats Healthy?

FDA 130

FDA Governance Medicaid Medicaid 130

HIT Consultant

JULY 16, 2024

Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We But there’s a lot of reasons to be optimistic.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

Healthcare It News

DECEMBER 12, 2022

Within the HITRUST-certified ecosystem, providers across sectors identify social care needs, make and receive referrals, report on results and manage payments from paid social care programs, government funding, grants, philanthropic investments and hospital community benefit dollars, according to the company's website. THE LARGER TREND.

Medicaid 297

Medicaid Medicaid Governance Hospitals 297

Bill of Health

JUNE 15, 2023

Merck alleges that the price negotiation program operates as a price control because it effectively requires manufacturers to accept the maximum fair price as a condition of participation in Medicare and Medicaid. For example, under the Fifth Amendment, a taking only occurs where the government fails to provide “just compensation.”

Medicare 195

Medicare Medicare Medicaid Medicaid 195

HIT Consultant

JULY 20, 2022

Kristen Ballantine, VP of Government Relations at Gainwell. However, with the CMS Interoperability and Patient Access Final Rule , consumers, specifically Medicaid members, there is a greater push to give access to, and ownership of, this data. About Kristin Ballantine.

Governance 97

Governance Medicaid Medicaid Public Health 97

Healthcare It News

APRIL 29, 2024

Salesforce for public health and other government agencies could integrate natural language processing to ease administrative burdens and generate richer case files. With the new platform, government users would also be able to leverage Appointment Assistant, Slack and Visual Remote Assistant.

Public Health 304

Public Health Governance Medicaid Medicaid 304

Center for Health Insurance Reform

MAY 16, 2023

Most states rely on the federal government to run their Marketplace, but recently, several states have expressed interest in taking over Marketplace operations. It may be time for the federal government to establish a stronger federal floor. But federal rules impose few standards for states launching and maintaining a Marketplace.

Health Insurance 98

Health Insurance Governance Medicaid Medicaid 98

Fierce Healthcare

FEBRUARY 5, 2025

Government unions and cybersecurity experts are disturbed by Elon Musk's newfound access to personal information and the country's payment infrastructure, which coordinates funds for government health programs like Medicare and Medicaid.

Governance 140

Governance Medicaid Medicaid Medicare 140

Healthcare It News

OCTOBER 31, 2022

Through the secure collection, documentation, reporting, access and use of data across provider types, ONC aims to address health inequities that have their root causes in poverty and racism. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org.

Licensing 340

Licensing Medicaid Medicaid Health Outcomes 340

Center for Health Insurance Reform

MARCH 7, 2022

Health insurers reported healthy earnings during the fourth quarter of 2021, thanks in large part to publicly funded programs Medicare and Medicaid. CHIR's Megan Houston reviewed earnings reports for nine major insurers and reports on the key market trends in the health insurance industry.

Governance 97

Governance Health Insurance Medicaid Medicaid 97

HIT Consultant

OCTOBER 22, 2024

Making HPH-CPGs a Condition of Participation (CoP) for CMS : The Centers for Medicare & Medicaid Services (CMS) could require adherence to HPH-CPGs as a condition for participating in Medicare and Medicaid programs. Two potential strategies for implementing these requirements include: 1.

HIPAA 139

HIPAA Compliance Public Health Medicaid 139

Compliancy Group

JANUARY 23, 2025

The federal False Claims Act prohibits someone from knowingly presenting or causing a false claim for payment if the federal government will pay for that claim. Crossroads: $863,934 Allegations that the substance use disorder treatment clinics billed for treatment services they did not provide, defrauding Medicaid. While the $1.67

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

HIPAA Journal

JULY 31, 2023

a government services contracting company, has announced in a Securities and Exchange Commission (SEC) filing that hackers exploited a zero-day vulnerability in Progress Software’s MOVEit Transfer solution in May 2023 and accessed the protected health information (PHI) of between 8 and 11 million individuals. Reston, VA-based Maximus Inc.,

Governance 95

Governance Medicare Medicare Ransomware 95

HIPAA Journal

NOVEMBER 17, 2022

Caroline Cook, Privacy Consultant, GDH Government Consulting Services, has shared her thoughts. I’m a Privacy Consultant employed by GDH Government Consulting Services. I’m currently on contract to a State Medicaid Agency’s Privacy Office. Tell the readers about your career in the healthcare industry.

Governance 104

Governance HIPAA Compliance Nursing Homes 104

Healthcare IT Today

JANUARY 20, 2025

My career spans over three decades in health information technology, health policy and public health, including roles at the Centers for Medicare and Medicaid Innovation and in state government. What are some of the government initiatives and reimbursements that support this approach?

Governance 67

Governance Medicaid Medicaid Health Outcomes 67

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7

Medicaid 99

Medicaid Medicaid Medicare Medicare 99

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 98

Medicaid Medicaid Ransomware Health Insurance 98

AIHC

APRIL 22, 2025

Atkins, PhD, MSW, LMSW, CPC, CIGE The governments new whistleblower complaint portal launched in April 2025 emphasizes the importance of complying with regulations related to qui tam suits, OCR investigations and protecting the rights of employees submitting a tip or complaint internally or to authorities. Written by Dr. Stacey R.

Compliance 89

Compliance HIPAA Compliance Officers Fraud 89

Healthcare IT News - Telehealth

JUNE 8, 2020

"Regrettably, minority groups are being left behind by the telehealth revolution," said David Smith, executive director for the Medicaid Transformation Project, in an interview with Healthcare IT News. " David Smith, Medicaid Transformation Project Executive Director.

COVID-19 216

COVID-19 Medicaid Medicaid Telemedicine 216

Fierce Healthcare

OCTOBER 8, 2024

Texas is halting the state’s new Medicaid contracts, a district judge declared Oct. A Texas judge sided with four health over plans over the state government. The state's Medicaid procurement process was deemed unfair.

Medicaid 69

Medicaid Medicaid Governance 69

Healthcare It News

JANUARY 18, 2022

Social determinants of health are major contributors to health inequity and rising healthcare costs in vulnerable populations such as Medicaid beneficiaries. For example, training a predictive model on the general population may be inaccurate when used in a Medicare or Medicaid population.

COVID-19 363

COVID-19 Medicaid Medicaid Patient Satisfaction 363

Verisys

APRIL 8, 2025

FACIS Level 1M Background Check A FACIS Level 1M background check is the recommended baseline and minimally required compliance search for candidates employed by organizations that receive any government funding for state or federal health care programs. The post What is FACIS?

Fraud 52

Fraud Medicaid Medicaid Compliance 52

Healthcare IT News - Telehealth

APRIL 14, 2025

It's April 2025 and healthcare still waits for a permanent solution from the government for telemedicine and Medicare – which tends to drive what Medicaid and private insurers do. The current ones run out on September 30. Will October 1 find the industry with a permanent solution or another kick of the can down the road?

Telemedicine 124

Telemedicine Medicare Medicare Medicaid 124

Healthcare IT Today

JANUARY 2, 2025

The dataset is derived from more than 450 suppliers, including employers, health plans, and state Medicaid agencies, offering a comprehensive view to broadly understand healthcare trends for U.S. About Merative Merative provides data, analytics, and software for healthcare and government social services. Visit morganhealth.com.

Governance 103

Governance Medicaid Medicaid 103