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Healthcare Dive
DECEMBER 20, 2022
The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program.
323 
Healthcare Dive
OCTOBER 23, 2024
The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.
284
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Healthcare Dive
JANUARY 29, 2025
incorrectly said that Medicaid was fully funded by the federal government and that Medicare is a fee-for-service program during a hearing in front of the Senate Finance Committee on Wednesday. Kennedy Jr.
356 
Healthcare Dive
JANUARY 3, 2025
The $100 million settlement is one of the larger recent sums agreed to by an MA payer accused of inflating its members’ sicknesses to get higher reimbursement from the government.
322 
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
332 
Electronic Health Reporter
DECEMBER 18, 2024
By Don Rucker, MD, chief strategy officer, 1up Health Medicare Advantage is a capitated health plan and the government, which pays for the plan, needs massive amounts of performance data to ensure that plans do […] The article How is Medicare Advantage Policy Forcing Changes in Payer Tech Stacks?
91 
Healthcare Dive
JANUARY 30, 2024
However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.
184 
Healthcare Dive
APRIL 24, 2024
The states' proposals, which resemble Medicare for All, need approval from the federal government and face pushback from major health systems and insurers.
307 
Healthcare Dive
OCTOBER 1, 2024
Threatened with steep sanctions and loss of its agreement with Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.
201 
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.
301 
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.
246 
Healthcare Dive
MARCH 9, 2023
Released Thursday, the budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.
Fierce Healthcare
AUGUST 27, 2024
A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)
131 
Healthcare IT News - Telehealth
JUNE 19, 2023
Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.
172 
HIT Consultant
JANUARY 5, 2025
government alleged that between January 2017 and November 2022, Meditelecare submitted claims to Medicare for telehealth psychotherapy sessions that did not meet the minimum time requirements for reimbursement. The settlement was announced today by U.S. Attorney Michael A. Bennett of the Western District of Kentucky. – The U.S.
52 
Kaiser Health News
JANUARY 28, 2022
A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursing home care, and no way to challenge a denial. But it can have serious repercussions.
145 
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.
133 
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. A classic example is Medicare fraud. Medicare Advantage Matters Medicare Part C is the largest part of Medicare. While the $1.67
98 
Fierce Healthcare
NOVEMBER 20, 2023
Traditional Medicare paid out an estimated $31.2 billion in improper payments in fiscal year 2023, according to new data from the federal government. |
130 
Fierce Healthcare
OCTOBER 2, 2023
government that it submitted false and inaccurate Medicare Advantage diagnostic codes in a bid to boost its reimbursement. Cigna will pay $172 million to settle allegations brought by a whistleblower and the U.S. Cigna will pay $172 million to settle allegations brought by the U.S.
140 
Fierce Healthcare
FEBRUARY 15, 2024
Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months. ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme.
126 
Healthcare It News
SEPTEMBER 27, 2024
Australian gov't urged to raise My Health Record funding An organisation of general practitioners in Australia has called on the federal government to upgrade the country's digital health record system. Recently, the country's Productivity Commission found My Health Record "plagued by incomplete records and poor usability."
306 
Healthcare It News
SEPTEMBER 16, 2024
There's help for providers who want to help aging patients navigate complex government websites and access the information and resources they need to overcome isolation, lack of transportation and limited financial resources barring full access to healthcare opportunities. This raises a critical concern.
311 
Bill of Health
JUNE 15, 2023
By Laura Dolbow Merck recently filed a lawsuit that challenges the constitutionality of the Medicare price negotiation program created by the Inflation Reduction Act. Merck argues that this form of price regulation charts a “ radical new course ” for Medicare that violates the Takings Clause of the Fifth Amendment.
195 
Medisys Compliance
DECEMBER 19, 2024
From managing CPT codes for procedures like nail debridement and wound care to ensuring compliance with Medicares podiatry-specific guidelines, the billing process can be confusing. Specialized podiatry billing services ensure adherence to unique guidelines such as those governing routine foot care, diabetic foot exams, and nail care.
Healthcare IT Today
DECEMBER 22, 2024
Access to home health for Medicare beneficiaries is decreasing , according to a recent report from Trella Health, with the number of home health visits per day down more than 17% between 2017 and 2023. That said, rejection rates hit a trough in 2018 and have increased 16% since then.
87 
Healthcare It News
FEBRUARY 20, 2025
Expanded adoption of AI Healthcare providers were leveraging AI tools in 2024; however, there was a major focus on governance, and many of the use cases were focused on operational efficiency. And third, the focus this year will expand to include the caregiver experience alongside the patient experience.
248 
Kaiser Health News
FEBRUARY 8, 2022
The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. The total amount of the penalties is determined by how much each hospital bills Medicare.
127 
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.,
96 
Healthcare It News
NOVEMBER 23, 2023
Victoria to complete Altera EMR rollout across Gippsland The state government of Victoria has committed to finishing the deployment of an integrated EMR system across the rural region of Gippsland. It recently announced A$12 million in funding over four years to support health services in the region to upgrade their systems.
325 
Healthcare IT Today
JANUARY 23, 2025
Shah, Co-Founder and CEO at Dina Payers Lean on Technology to Coordinate New Innovative Supplemental Benefits to Improve Quality, Outcomes, and Costs for Seniors Non-medical supplemental benefits like in-home support services, meal delivery, home modifications, and transportation have skyrocketed with Medicare Advantage (MA) plans.
96 
Healthcare IT News - Telehealth
JANUARY 17, 2022
The Australian government is briefly subsidising some telehealth services as it deals with a new COVID-19 outbreak. These include specialist inpatient video and phone consultation items under the Medicare Benefits Schedule, complex specialist telephone consultations and level C or longer telephone consultations for general practitioners.
217 
Healthcare IT News - Telehealth
OCTOBER 18, 2022
The Australian government is restoring its subsidy for bulk-billed video telehealth psychiatry consultations through a A$47.7 This comes as the latest funding will restore 50% fee loading to bulk billed Medicare Benefits Schedule (MBS) psychiatry services delivered by video telehealth. WHY IT MATTERS. THE LARGER CONTEXT.
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Hall Render
JANUARY 29, 2025
The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. Hospice surveys are performed before their initial certification for Medicare participation. Identifying Fraud : Detecting practices that jeopardize patient safety or Medicare program integrity.
80 
Healthcare IT News - Telehealth
APRIL 30, 2021
The act would expand coverage of Medicare telehealth services and make some COVID-19 telehealth flexibilities permanent, among other provisions. Access for Medicare beneficiaries. Questions about the future of telehealth regulations have endured ever since the federal government opted to relax some of them during the COVID-19 pandemic.
218 
Healthcare It News
MARCH 2, 2023
The Strengthening Medicare Task Force , which was formed to identify the most pressing investments needed in Australia's primary care sector, r ecently suggested modernising the "clunky" MHR, among other recommendations it forwarded to the government.
335 
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.
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.
342 
Healthcare IT News - Telehealth
JANUARY 30, 2023
FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. While it made "significant" changes to the Medicare Benefits Schedule (MBS), the expanded telehealth services were "only partly supported by sound implementation arrangements.
188 
Healthcare IT News - Telehealth
JULY 23, 2020
Wolf also pointed out that the recent bloom in telehealth is rooted, in part, in the government's electronic health record incentive program and meaningful use. She also pointed out that many state governments have also been in limbo waiting for the federal government to take action. " she said.
215 
Healthcare IT News - Telehealth
DECEMBER 12, 2021
The Australian government has set aside A$106 million ($76 million) over four years to support what it calls "permanent" telehealth, which will ensure flexibility in healthcare delivery and continuous health consultations via phone or online. WHY IT MATTERS. Around 89,000 providers are now using telehealth services. million ($22.8
211 
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.
139 
Fierce Healthcare
MARCH 10, 2025
House Speaker Mike Johnson and House appropriators released bill text for a continuing resolution that would fund the government for six months. like the one Congress passed in December, extends certain healthcare programs, like Medicare telehealth but excludes reforms for Medicare physician pay and pharmacy benefit managers.
134 
Healthcare It News
AUGUST 29, 2024
"She has been a key contributor to the advancement of digital health in the nursing profession and played a pivotal role in the future of the Australian healthcare system as a member of the Strengthening Medicare Taskforce," ADHA CEO Amanda Cattermole said about Booth in a statement.
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