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24 May 2024, 9:46 am
All this was in addition to several False Claims Act criminal proceedings this week, including the conviction of a Nevada doctor for defrauding Medicare/Medicaid by referring medically unnecessary prescriptions to a pharmacy in exchange for kickbacks; the guilty plea of a Texas woman for fraudulently receiving Coronavirus Aid, Relief, and Economic Security (CARES) Act unemployment benefits; and the indictment of a Brooklyn woman for scheming to submit… [read post]
HHS Inspector General Reiterates Commitment to Combating Healthcare Fraud, Highlights Areas of Focus
23 Apr 2024, 11:57 am
” Durable Medical Equipment (DME) Fraud: DME fraud “persisted in traditional Medicare for decades and is growing in Medicare managed care. [read post]
25 Mar 2024, 12:29 pm
” See: Health Care Fraud Defense: Arrests Based Upon Medicare, Medicaid, or TriCare Insurance Claims. [read post]
13 Mar 2024, 10:43 am
Recently, the Centers for Medicare & Medicaid Services (CMS) announced that it will accelerate payments for Medicare Part A providers and Part B suppliers. [read post]
23 Feb 2024, 5:00 am
In the Medicare Advantage (MA) program, overseen by the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Organizations (MAOs) – typically private insurers – receive monthly payments from CMS. [read post]
20 Feb 2024, 5:00 am
Among the plethora of different contractors used by the Centers for Medicare & Medicaid Services (CMS) to administer the Medicare program is the Supplemental Medical Review Contractor, or SMRC. [read post]
16 Feb 2024, 2:35 pm
., a durable medical equipment supplier with locations throughout the country. [read post]
13 Feb 2024, 5:00 am
The Stark Law (42 U.S.C. 1395nn) prohibits doctors from referring patients to entities providing “designated health services” covered by Medicare or Medicaid if there is a financial relationship between the physician (or their immediate family) and the entity, except under specific exceptions. [read post]
1 Feb 2024, 5:00 am
When a provider or supplier enrolls in Medicare, it must provide a series of addresses, including a correspondence address, medical review address, and payment address. [read post]
28 Dec 2023, 12:56 pm
The Government views them as an integral part of the Medicare and Medicaid programs. [read post]
22 Dec 2023, 2:31 pm
” This standardized regulatory program permitted OPM to effectuate sanctions issued by other agencies (including those issued by the HHS OIG in connection with Medicare and Medicaid exclusion actions. [read post]
13 Dec 2023, 1:00 am
COMPANY AGREES TO PAY $200,000 TO RESOLVE FALSE CLAIMS ACT ALLEGATIONSA Kentucky medical equipment supplier, known as Oxygen Plus, Inc., recently agreed to resolve a False Claims Act claim brought against the company for $200,000.From 2017 to 2021, the company allegedly submitted some 300 false claims to Medicare and Medicaid for respiratory devices, called non-invasive ventilators, that patients “did not need or use. [read post]
17 Nov 2023, 5:26 am
The Centers for Medicare & Medicaid Services (CMS) has published its final rule that requires nursing homes enrolled in Medicare and Medicaid to disclose additional ownership and management information to CMS and state Medicaid agencies. [read post]
13 Nov 2023, 5:40 pm
It creates crimes that are considered to protect the patient’s best interests by outlawing even the offer to exchange any kind of remuneration (even if it never happens) to get referrals for services or to get items that are eligible for monetary reimbursement under federal healthcare programs (e.g., Medicare, Medicaid, Tricare). [read post]
10 Nov 2023, 1:35 pm
The Revenue Procedure also adjusts the deductible required for a health plan to qualify as a “high deductible health plan” (“HDHP”) for which the Code allows tax preferred contributions to Medical Savings Accounts (“MSAs”). [read post]
9 Nov 2023, 1:48 pm
This involvement encompasses helping health care systems and organizations, group and individual health care providers, health plans and insurers, health IT, life sciences and other health industry clients prevent, investigate, manage and resolve sexual assault, abuse, harassment and other organizational, provider and employee misconduct and other performance and behavior; manage Section 1557, Civil Rights Act and other discrimination and accommodation, and other regulatory,… [read post]
9 Nov 2023, 1:07 pm
The Revenue Procedure also adjusts the deductible required for a health plan to qualify as a “high deductible health plan” (“HDHP”) for which the Code allows tax preferred contributions to Medical Savings Accounts (“MSAs”). [read post]
5 Nov 2023, 3:10 pm
OCR’s investigation determined that, in addition to that impermissible disclosure, DADS violated the HIPAA Security Rule by failing to conduct an enterprise-wide risk analysis and implement access and audit controls on Community Living Assistance and Support Services and Deaf Blind with Multiple Disabilities (“CLASS/DBMD”) program information systems and applications intended to collect and report information about “Utilization Management and Review” activities to the… [read post]
10 Oct 2023, 10:51 am
During FY 2022, the Centers for Medicare and Medicare Services (CMS) has estimated the Medicare Part B improper payment rate as 8.41%. while the improper payment rate for Durable Medical Equipment (DME) suppliers was estimated to be 25.24%.[2] Additionally, the Medicaid program improperly paid $80.6 billion in improper claims during FY 2022.[3] Notably, these estimates don’t even take into account the sizeable improper billings submitted to… [read post]
4 Sep 2023, 7:27 am
HHS is announcing important new steps to crack down on nursing homes that endanger resident safety: The Centers for Medicare & Medicaid Services (CMS) is proposing a rule to set a federal floor for staffing levels, so that nursing home owners could not slash staffing to unsafe levels. [read post]
