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.

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Governance Health Insurance Medicaid Medicaid 133

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.

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Medicaid Medicaid Medicare Medicare 305

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 65

Medicaid Medicaid Governance 65

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.

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Fraud Governance Medicaid Medicaid 246

Healthcare Dive

DECEMBER 20, 2022

trillion omnibus spending package as they near a Friday deadline for government funding. Lawmakers are rushing to speed passage of the $1.7

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Medicaid Medicaid Medicare Medicare 334

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).

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Medicaid Medicaid Governance COVID-19 103

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.

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Medicaid Medicaid Health Insurance Health Outcomes 105

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.

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Medicaid Medicaid Medicare Medicare 143

MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

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Governance Compliance Nursing Homes Medicaid 52

Healthcare IT News - Telehealth

MARCH 18, 2022

Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. Fortunately, government, investors and startups are working together to close some of these care gaps. What's happening in this area of digital health?

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Medicaid Medicaid COVID-19 Telemedicine 203

MedTrainer

NOVEMBER 14, 2023

While federal operations are slowed, reduced, or put on pause during a government shutdown, healthcare services must continue to operate. What Is a Government Shutdown? Without budget authorization from Congress, a variety of government services and operations come to a halt. But what does this mean for your healthcare business?

Governance 52

Governance Medicaid Medicaid Medicare 52

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.

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Health Insurance Governance Medicaid Medicaid 98

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.

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Medicaid Medicaid Public Health Governance 264

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.

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Governance Medicaid Medicaid Public Health 97

HIT Consultant

NOVEMBER 9, 2023

Director of Healthcare Strategy, LexisNexis Risk Solutions During the peak of the Covid-19 pandemic, over 10 million Americans enrolled in Medicaid – nearly a 14% increase from the beginning of 2020. A month before the public health emergency ended on May 11, 2023, 87 million individuals were enrolled in Medicaid.

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Medicaid Medicaid Health Insurance COVID-19 64

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 79

Governance Medicare Medicare Ransomware 79

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.

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Governance Public Health Local Policy Medicaid 306

Healthcare Law Blog

AUGUST 25, 2023

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.

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Overpayments Overpayment Medicaid Medicaid 52

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.

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Medicaid Medicaid Ransomware Health Insurance 89

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.

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Governance Health Insurance Medicaid Medicaid 97

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

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Medicaid Medicaid Licensing Medical Billing Outsourcing 52

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.

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Governance HIPAA Compliance Nursing Homes 96

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

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Medicaid Medicaid Medicare Medicare 86

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.”

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Medicare Medicare Medicaid Medicaid 196

Healthcare IT News - Telehealth

APRIL 6, 2022

Enterprise Taxonomy: Node settings: Exclude from Accelerate RSS feed

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Governance Medicaid Medicaid 115

Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Compliance 59

Kaiser Permanente

DECEMBER 24, 2021

Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements and is jointly funded by states and the federal government. Virginia’s Medicaid program is known as Medallion Medicaid.

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Medicaid Medicaid Governance 52

Fierce Healthcare

MARCH 27, 2024

A new report finds that the federal government made nearly $236 billion in improper payments across entitlement programs last year, with Medicare and Medicaid a large source of payment errors. |

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Medicaid Medicaid Medicare Medicare 108

Bill of Health

NOVEMBER 15, 2023

drug policy using a whole-of-government (W-G) approach to assess where these misalignments are occurring among different agencies at the same level of government (referred to as horizontal W-G), and across different levels of government (referred to as vertical W-G).

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Governance Public Health Telemedicine Medicaid 174

Healthcare Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-417836, 2020 CPD ¶ 47 ( Nov.

Governance 52

Governance Department of Veterans Affairs Medicaid Medicaid 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.

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Medicaid Medicaid Compliance Governance 59

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Nursing Homes 59

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

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Medicaid Medicaid ACA Public Health 52

C&M Health Law

APRIL 21, 2022

Department of Justice (DOJ) to resolve allegations that it had made donations in order to improperly inflate the funding four of its hospitals received from the federal Medicaid program. Florida Medicaid is administered by the state but jointly funded by both the state and federal governments.

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Medicaid Medicaid Governance Fraud 52

HIPAA Journal

FEBRUARY 8, 2024

Department of Health & Human Services Office of Inspector General (HHS-OIG) has published a Roadmap for New Physicians on avoiding Medicare and Medicaid fraud and abuse. The post Advice for New Physicians on Avoiding Medicare and Medicaid Fraud and Abuse appeared first on HIPAA Journal.

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Fraud Medicaid Medicaid Medicare 40

Hall Render

JUNE 23, 2023

In the latest effort to increase price transparency and lower prescription drug costs, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule (“Proposed Rule”) that, in part, intends to reveal the actual cost of drugs covered by Medicaid.

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Medicaid Medicaid Governance Medicare 40