AIHC

SEPTEMBER 30, 2024

This was originally mandated by the Centers for Medicare & Medicaid Services (CMS) back in 1997 and implemented in 2004. The OIG made the following recommendations to Humana: Refund to the Federal Government the $6.8 HCC coding relies on ICD-10-CM coding to assign risk scores to patients.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

The Health Law Firm

FEBRUARY 20, 2018

million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

Overpayments 40

Overpayments Overpayment Medicaid Medicaid 40

Florida Health Care Law Firm

DECEMBER 2, 2021

As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”. Any overpayment retained after this period may create liability under the Civil Monetary Penalties Law and the False Claims Act.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. Allegedly, the facility also failed to fully reimburse the government for its receipt of these outlier payments after it became aware of the issue. Return illegitimate reimbursement and overpayments quickly.

Compliance 52

Compliance US Department of Health and Human Services Overpayment Overpayments 52

Innovaare Compliance

MARCH 1, 2022

1] The Centers for Medicare & Medicaid Services (CMS) has to establish an annual Part B premium that will adequately fund projected Medicare spending and maintain an adequate reserve in case actual costs are higher than estimated. 6] Improper payments can be overpayments and underpayments. in 2021 to $170.00

Medicare 52

Medicare Medicare Overpayment Overpayments 52

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 million (net) and $4.7 billion from 2023 through 2032, including extrapolation effects.

Overpayment 52

Overpayment Overpayments Medicare Medicare 52

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability.

Fraud 59

Fraud Compliance Medicare Medicare 59

Health Law RX

NOVEMBER 9, 2021

The updated SDP makes several important revisions and clarifications that directly impact providers and suppliers who seek to self-disclose potential violations of healthcare fraud statutes to the government. The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayment Overpayments Governance 52

YouCompli

SEPTEMBER 27, 2023

Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid.  She also claimed the hospital failed to reimburse payors for overpayment stemming from these improperly coded claims.

Compliance 52

Compliance Overpayment Overpayments Medicare 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements. 2021, January 15).

Fraud 52

Fraud Compliance Health Insurance Medicaid 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements. 2021, January 15).

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

YouCompli

SEPTEMBER 13, 2023

Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. There also should be education on other important, but less recognizable, types of Medicare or Medicaid fraud.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Fraud Compliance 52

AIHC

OCTOBER 23, 2024

Defined Criteria” are standards identified in advance and approved for use in a specific audit, generally set by government rules, regulations or government agencies, such as CMS or pre-approved by the governing board of your organization. Corrective action includes refunding overpayments revealed during the audit.

Compliance 52

Compliance Overpayment Overpayments Medicaid 52

Hall Render

DECEMBER 11, 2024

The Proposed Rule would codify changes made by the Medicaid Services Investment and Accountability Act of 2019 (MSIAA), that added exclusion authorities related to misclassification and false information about outpatient drugs.

Compliance 40

Compliance Licensing Nurses Medicaid 40

AIHC

SEPTEMBER 5, 2023

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. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

C&M Health Law

DECEMBER 18, 2023

OIG specifically references the United States Sentencing Commission’s Guidelines that require that an entity’s “governing authority shall be knowledgeable about the content and operation of the compliance and ethics effectiveness of the compliance and ethics program.”

Compliance 52

Compliance Compliance Officers Governance Overpayment 52

AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Medicare Medicare Compliance 52

The Health Law Firm Blog

AUGUST 23, 2022

Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.].

Medicare 52

Medicare Medicare Hospitals Governance 52

AIHC

FEBRUARY 17, 2025

There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. The list of terms and definitions used throughout are below for reference.

Fraud 52

Fraud Compliance Overpayment Overpayments 52

Hall Render

NOVEMBER 25, 2024

When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, the claim submission form includes certifications that the claimed services were provided in compliance with all applicable statutes, regulations and rules.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

The Health Law Firm Blog

NOVEMBER 18, 2023

Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.]

Medicare 40

Medicare Medicare Hospitals Governance 40

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Mary’s unveils new name, but mission remains unchanged UCHealth sues thousands of patients every year. What they say sets them apart.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

MAY 10, 2024

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.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). We’ve summarized some of the key changes in the Proposed Rule. Comments on due February 13, 2023. Star Ratings.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

APRIL 26, 2024

million Medicaid enrollees in 12 months; one month left in ‘unwinding’ University of Maryland Medical Center physicians unionize, a first in the state Emergency room wait times are worse than bad. in 256-Slice CT scanner Lifepoint reports $200M+ economic impact in Cen Ky St. health dept. processed 1.5

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Medicaid 40

HIPAA Journal

MARCH 30, 2022

However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away. It was only when the provisions of a companion bill ( HR.3103 It was not until 2002 that the Privacy Rule was published, and 2003 that the Security Rule was published.

HIPAA 137

HIPAA Fraud Health Insurance Health Care Reform 137

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 Medicaid systems are struggling as potential expansion looms Clearly, many state unemployment information systems are in dire need of upgrades. For Medicaid, the threat comes as potential expansion looms. Centers for Medicare and Medicaid Services (CMS) reimbursed states $34.3

Medicaid 52

Medicaid Medicaid COVID-19 Overpayment 52

Hall Render

JANUARY 19, 2024

Francis emergency room KENTUCKY Apollo’s 220-hospital ‘stranglehold’ harms patients and workers, report alleges Humana cuts ‘small’ number of jobs in multiple locations LMU School of Nursing will open Lexington site at CHI Saint Joseph Health Mercy Health announces acquisition of orthopedic center in Paducah, Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Kaiser Health News

JUNE 29, 2022

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. ” The health plan required patients to have an X-ray first to prove a CT scan was needed.

Medicare 107

Medicare Medicare Governance Overpayment 107

Hall Render

MARCH 22, 2024

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

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

Kaiser Health News

OCTOBER 13, 2022

For the first time, Medicare Advantage plans are poised to enroll more than half of the Medicare population despite allegations that many of the largest insurers are getting billions of dollars in overpayments from the federal government.

ACA 74

ACA Medicare Medicare Governance 74