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18 Jan 2022, 7:33 am
An FDA sister agency, the Centers for Medicare and Medicaid Services (CMS), has joined the Department of Veterans Affairs in sharply restricting Aduhelm’s use and coverage for payment. [read post]
17 Nov 2008, 5:00 am
The remaining 74 facilities on the list were released only to provider associations, and, in part, to various state health departments — only some of whom made their in-state names public.McKnight's sources have indicated that the list has expanded beyond the 128 facilities originally selected. [read post]
18 Jan 2012, 4:26 pm
The mounting guilty pleas and convictions obtained from individuals who participated in the execution of the scheme since the Justice Department secured guilty please from ATC, ASI and their owners shows that individuals electing to participate in aggressive Medicare referral or billing practices by their health care companies or other business partners stand a high risk of criminal prosecution if their organizations get caught engaging in health care fraud. [read post]
8 Jul 2022, 11:10 am
The DOJ highlighted health care fraud as “the leading source of the department’s False Claims Act settlements and judgments. [read post]
21 Jun 2016, 12:53 pm
A new OIG report examines CMS’s oversight of Medicare billing by provider-based facilities – that is, facilities that operate under the ownership, administrative, and financial control of a hospital and meet other requirements, and that bill as an outpatient department of the hospital rather than a freestanding facility. [read post]
8 Apr 2018, 7:19 pm
Not only could the health insurance or health services be canceled or reduced, some health insurance carriers take the same position as Medicare and require exhaustion of earmarked benefits before providing coverage. [read post]
20 Jun 2016, 11:57 am
The Department of Health and Human Services (HHS) attributes the growth in appeals in part to the expanded recovery audit claim denials entering the appeals process in FY 2011, along with a greater propensity among providers and suppliers to appeal denied claims. [read post]
19 Mar 2019, 11:30 am
Department of Health and Human Services (“HHS”) proposes to eliminate the rebates that pharmacy benefit managers (“PBMs”) receive from drug manufacturers and to encourage that any rebates go directly to seniors at the point of sale. [read post]
1 Jul 2011, 6:49 am
On June 23, 2011, the Departments of Justice and Health and Human Services announced that, under the aegis of the inter-agency Health Care Fraud Prevention and Enforcement Action Team (HEAT) program, three employees of the Solstice Wellness Center, a Brooklyn-area clinic that purported to specialize in providing physical therapy and diagnostic tests, have pleaded guilty to one count of conspiracy to commit health care fraud, in connection with a $3.4 million… [read post]
26 Jul 2018, 7:38 am
Home Health Payment Rate Update Rebasing and Revising of Home Health Market Basket CMS proposes to rebase and revise the home health market basket to reflect 2016 Medicare cost report data. [read post]
30 Jan 2012, 4:33 am
Kaiser Health News reported the disturbing but all too common story of Medicare fraud involving hospice and nursing homes. [read post]
23 Jan 2010, 3:36 pm
Department of Health & Human Services operates the Centers for Medicare and Medicaid Services (CMS). [read post]
23 Sep 2021, 11:55 am
Polite Jr. of the Justice Department’s Criminal Division; Assistant Director Calvin Shivers of the FBI’s Criminal Investigative Division; and Special Agent in Charge Lamont Pugh III of the Department of Health and Human Services, Office of Inspector General (HHS-OIG) made the announcement. [read post]
13 Aug 2021, 10:43 am
As the UHC court explained, “[t]o enable CMS to apply those relative factors to pay Medicare Advantage insurers at the correct risk-adjusted rate, the insurers must report to CMS the salient demographic and health characteristics of each of their Medicare-eligible beneficiaries. [read post]
7 Apr 2016, 9:28 am
Department of Health and Human Services and Office of Inspector General ("government") alleged that from 2007 to 2011, Dr. [read post]
17 Nov 2020, 1:40 pm
Read the Department of Justice’s press release here. [read post]
28 Jan 2013, 9:00 am
The pharmacy owner and his mother are allegedly being investigated by the US Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). [read post]
28 Jan 2013, 9:00 am
The pharmacy owner and his mother are allegedly being investigated by the US Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). [read post]
28 Jan 2013, 9:00 am
The pharmacy owner and his mother are allegedly being investigated by the US Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). [read post]
7 Oct 2011, 1:18 pm
Department of Health and Human Services, Office of Inspector General for the Chicago Region. [read post]
