Medisys Compliance

JULY 5, 2022

What is Medicare Overpayment? An overpayment is a payment made to a provider exceeding amounts due and payable according to existing laws and regulations. Identified overpayments are debts owed to the federal government. Laws and regulations require CMS recover overpayments. Medicare Overpayment Collection Process.

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Overpayments Overpayment Medicare Medicare 52

Healthcare IT Today

FEBRUARY 17, 2023

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). How can such overpayments be uncovered? public in overpayments. But the needles pile up fast.

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Overpayments Overpayment COVID-19 Medicare 107

Modern Healthcare

JULY 28, 2022

An OIG audit outlined millions in uncollected overpayments, holes in internal accounting system

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Overpayments Overpayment Medicare Medicare 115

Healthicity

FEBRUARY 8, 2022

In a recent audit of a New York hospital, the HHS OIG identified overpayments. New York Hospital to Pay $389,000 to Medicare.

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Overpayments Overpayment Medicare Medicare 98

Fierce Healthcare

NOVEMBER 7, 2022

Payers recover overpayments 50% faster with enterprise technology: study. Mon, 11/07/2022 - 12:43.

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Overpayments Overpayment 94

YouCompli

MARCH 22, 2023

There has been significant enforcement over the last couple years relating to overpayments for UDT. The overpayment rate for definitive drug testing for 22 or more drug classes was over 71%. Review at-risk payments made to at-risk providers during and after the OIG’s audit period and recover any overpayments.

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Overpayments Overpayment Compliance Medicare 52

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

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Overpayments Overpayment ACA Medicare 52

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.

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Overpayments Overpayment Medicare Medicare 40

Healthcare Dive

SEPTEMBER 5, 2023

The payer, which brings in the bulk of its revenue from Medicare, is fighting back against a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.

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Medicare Medicare Overpayments Overpayment 297

Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co. 3d 173 (Sep.

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Overpayments Overpayment Medicare Medicare 52

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

Fierce Healthcare

SEPTEMBER 30, 2021

Centene to pay more than $71M to settle Medicaid overpayment cases in Illinois, Arkansas. Thu, 09/30/2021 - 16:43.

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Overpayments Overpayment Medicaid Medicaid 105

Healthcare Dive

JUNE 1, 2022

Consumers are overpaying for generic drug prescriptions by as much as 20% due to pharmacy benefit manager practices like copay clawbacks and spread pricing, researchers found.

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Overpayments Overpayment 310

Healthcare Dive

FEBRUARY 2, 2023

Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

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Overpayments Overpayment 246

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs. Background RADV audits are the main tool that CMS uses to correct overpayments made to MAOs.

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Overpayments Overpayment Medicare Medicare 40

Healthcare Dive

SEPTEMBER 6, 2023

Favorable selection of healthier beneficiaries led to overpayments in counties with high Medicare Advantage penetration, but benchmark changes could mitigate the impact, according to a study published in Health Affairs.

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Overpayments Overpayment Medicare Medicare 154

Fierce Healthcare

JUNE 13, 2023

Legislators and policymakers have put payments to Medicare Advantage (MA) plans under the microscope, and new analysis highlights why. Legislators and policymakers have put payments to Medicare Advantage plans under the microscope, and new analysis highlights why.

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Overpayments Overpayment Medicare Medicare 122

Fierce Healthcare

OCTOBER 19, 2023

The Mayo Clinic and LifePoint Health believe that collusion within pharmaceutical industry forced their organizations to overpay for the multiple myeloma drug Revlimid, and are petitioning the cour | The health systems said agreements between Revlimid's owners, Celgene and Bristol-Myers Squibb, and other drugmakers that delayed full production (..)

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Overpayments Overpayment Pharmaceutical Industry 126

Fierce Healthcare

JANUARY 2, 2024

Medicare Part D will cover certain over-the-counter products when prescribed by a clinician, and when it does, the program pays far more for these drugs, according to a

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Overpayments Overpayment Medicare Medicare 69

Healthcare Law Blog

FEBRUARY 1, 2023

Likewise CMS cited its fiduciary duty to protect taxpayer dollars from overpayments and its fiduciary responsibility to recover funds due to the Medicare Trust Funds. case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. The Court of Appeals reversed and reinstated the Overpayment Rule.

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Medicare Medicare Overpayments Overpayment 105

Healthicity

NOVEMBER 29, 2022

Health and Human Services Office of Inspector General (OIG) recently issued a report concluding that Medicare and patients combined overpaid more than a million dollars for the same professional services provided at critical access hospitals (CAH). Who Bills for Professional Services?

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Overpayments Overpayment Hospitals Medicare 52

The Health Law Firm

FEBRUARY 15, 2016

Board Certified by The Florida Bar in Health On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule which eased requirements for health care providers to return overpayments within 60 days to avoid False Claims Act (FCA) liability. Indest III, J.D., To read the final rule from CMS, click here.

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Overpayments Overpayment Medicare Medicare 40

HIT Consultant

SEPTEMBER 27, 2024

billion in overpayments to MA plans with this new audit methodology over the next ten years. Improving coding training and best practices Achieving better risk adjustment results starts with ongoing training efforts and proactively planning for overpayments. million in overpayments to just one plan over the course of two years.

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Overpayments Overpayment Medicare Medicare 52

AIHC

SEPTEMBER 30, 2024

First, although most of the diagnosis codes that EmblemHealth submitted were supported in the medical records and therefore validated 860 of the 1,222 sampled enrollees’ HCCs, the remaining 362 HCCs were not validated and resulted in overpayments. The OIG made the following recommendations to Humana: Refund to the Federal Government the $6.8

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Overpayments Overpayment Compliance Medicare 52

Healthicity

MARCH 4, 2022

The OIG continues to perform focused audits on hospital claims using billing data from thousands of hospitals.

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Overpayments Overpayment Hospitals Compliance 96

Modern Healthcare

MARCH 17, 2022

As Xavier Becerra approaches his one-year anniversary at HHS' helm, he's interested in working with Congress on Medicare Advantage overpayment issues and physician payment reform.

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Medicare Medicare Overpayments Overpayment 87

Healthcare IT Today

MAY 2, 2023

Founded in 1995, DCI’s payment integrity services provide millions of dollars of post payment overpayment identifications for clients. DCI has extensive experience in the health care field with over 28 years of experience servicing managed care clients.

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Overpayments Overpayment 110

Modern Healthcare

JULY 25, 2022

Providers that don't participate in the 340B program say CMS's plan would lead to unfair overpayments to 340B providers.

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Overpayments Overpayment 88

NEJM

JANUARY 13, 2023

A 2022 Supreme Court ruling raises questions about the 340B program’s outsized effect on the health care system’s structure and on the role of hospitals in providing care to underserved populations.

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Overpayments Overpayment Medicare Medicare 51

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. The defendants disagreed.

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Overpayments Overpayment Fraud Governance 52

Modern Healthcare

AUGUST 18, 2022

CMS could consider a policy more like the one it used to correct for overpayments to nursing homes, home health leaders said.

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Overpayments Overpayment Nursing Homes Nurses 76

Healthicity

APRIL 12, 2022

The OIG’s Annual Workplan for 2022 includes the continuous auditing and monitoring of items and services.

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Overpayments Overpayment Fraud Medicare 52

Healthcare IT Today

FEBRUARY 25, 2023

Read more… Retrieving Billions in Medicare Overpayments. Improper payments for Medicare are estimated to exceed $43 billion per year, and determining overpayments in open-ended value-based Medicare Advantage plans poses a problem. Read more… Fixing Medicare Advantage Payments.

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Overpayments Overpayment Ransomware Medicare 110

Health Law Advisor

FEBRUARY 2, 2023

For these years, CMS will limit payment recoveries to “enrollee-level adjustments,” i.e., the non-extrapolated overpayments identified in CMS RADV audits and Department of Health and Human Services Office of Inspector General (OIG) audits. CMS expects to recover a total of $4.7 This total includes $41.1

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Medicare Medicare Overpayments Overpayment 98

Health Care Law Brief

APRIL 12, 2023

Notable Omissions from Proposed Rule CMS declined to adopt previously proposed amendments to the standard for “identified overpayments” under Medicare Parts A, B, C, and D. The Social Security Act requires “a person” who has received an overpayment to report and return the overpayment no later than 60 days after being “identified.”

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Medicare Medicare Overpayments Overpayment 52

The Health Law Firm

FEBRUARY 27, 2013

Our firm has been consulted recently by owners of different health care entities, including assisted living facilities (ALFs), group homes, home health agencies and even medical groups that had received Medicaid overpayment demands. This resulted in a Medicaid overpayment assessment.

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Overpayments Overpayment Medicaid Medicaid 40

Provider Trust

JUNE 30, 2023

Maintaining the highest payment integrity standards helps payers avoid unnecessary payments, recover overpayments, and prevent fraud, waste, and abuse (FWA) in healthcare billing. In this model, healthcare claims are paid upfront, and then potential errors, overpayments, or fraudulent claims are “chased down” after payment has been made.

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Overpayments Overpayment Fraud Compliance 52