Medicare and medicaid

Indianapolis-based Elevance Health Inc. is facing a federal lawsuit alleging the company defrauded the U.S. government of millions of dollars by falsely certifying incorrect diagnostic data from doctors and other healthcare providers. In a ruling announced this week, Judge Andrew Carter of the U.S. District Court for the Southern District …

While health care may be the most important purchase most people will make in their lifetime, it is also the one they are least informed about. Despite legislative changes such as the law without surprise and the Centers for Medicare and Medicaid Services’ price transparency rulepatients in the United States …

As the open enrollment period approaches, many Medicare beneficiaries will be faced with the decision of whether to choose a traditional Medicare plan or opt for Medicare Advantage (MA). A recent report shows that there is little difference between the plans, with beneficiaries showing similar satisfaction rates. This month’s Kaiser …

Long before the Covid pandemic, it was important to ask, where are the mass movements to enact majority-supported change and reform in Congress? Another question: what happened to the mass gatherings that caught the attention of our 535 members of Congress to whom we gave our sovereign power? Let’s start …

Medicare, Medicaid, and Pharmacy Benefit Manager (PBM) audits can result in substantial losses for pharmacies. If auditors uncover evidence – or apparent evidence – of overpayments, not only can they initiate recoveries, but they can also dismiss pending claims, impose a pre-payment review of future claims, and impose other sanctions …

OKLAHOMA CITY – The Oklahoma Department of Insurance (OID) will host its annual Medicare Open Enrollment webinars every Tuesday in October. This 4-week webinar series will highlight different parts of Medicare, eligibility, enrollment options, and how beneficiaries can customize their Medicare plan to suit their needs. The webinars will take …

LAKE PLACID — The health of a person’s financial situation plays a role in their well-being situation, especially as we age. That is why Colleen McNallyOwner of Small town girl insurance of Lake Placidsponsored the 2022 Highlander Award for Financial Representative of the Year. “I can’t tell you how many …

District 7 Regional Agency on Aging (AAA7) has received Case Management Accreditation for Long-Term Services and Supports from the National Committee for Quality Assurance (NCQA) for its PASSPORT and Medicaid programs d assisted living for a period of two years. Earning NCQA Accreditation for Case Management for Long-Term Services and …

The U.S. Department of Health and Human Services (HHS) announced Monday that Oregon will be the first state in the nation to roll out a mobile crisis response program under Medicaid. The focus of the new program: behavioral health care. Leaders from HHS and the US Centers for Medicare & …

LINCOLN – A Nebraska A woman who lost her Medicaid coverage in the middle of cancer treatment is challenging a federal rule that required the state to cut it. Mary Shaw of Norfolk joins four plaintiffs from Connecticut and Delaware in a class action against US Department of Health and …

The Wisconsin Department of Health Services (DHS) is launching an online program for Wisconsin residents to get free rapid home COVID-19 tests delivered directly to them. Starting this week, Wisconsin residents can visit Say Yes! COVID Test website(link is external) and place an order for a set of five rapid …

Optometric care is one of the services — along with chiropractic, podiatric and dental care — for which a group of local health care centers say Arizona’s Medicaid agency has not reimbursed them. They claim that the law requires the services to be covered. (Photo by Leonardo Munoz/EPA/Shutterstock) WASHINGTON — …

Baltimore, Maryland, September 1st — The US Department of Health and Social Services Centers for Medicare and Medicaid Services issued the following press release on August 31, 2022: In a historic effort to improve access to health care for millions of Americans, the Biden-Harris Administration proposed a new rule to …

Medicaid Adult Dental Coverage Checker categorizes benefits to help identify potential areas for improvement BOSTON–(BUSINESS WIRE)–CareQuest Institute for Oral Health®, in partnership with the American Dental Association (ADA) Health Policy Institute, Center for Healthcare Strategies, Inc.and the National Academy of State Health Policy (NASHP), announced the release of an innovative …

(Missouri Independent) – Missouri has just over a month to bring its Medicaid program back into compliance with federal regulations, and state officials said Friday they were optimistic about meeting that deadline despite the average wait time for Medicaid applications still hovering around double what is allowed. The processing time …

The Centers for Medicare & Medicaid Services (“CMS”) recently published the proposed physician fee schedule for 2023 (“PSF”), which contains several important changes affecting accountable care organizations (“CO”) who participate in the Medicare Shared Savings Program (“MSSP”), including a new advanced incentive program. See PSF Proposal 2023, 82 Fed. Reg. …

The potential impact is seen as “relatively modest” as the industry is better positioned than it was during the 2008 recession. Slowing economic growth and inflation are the most likely headwinds for health insurers going forward, but their impact on the industry is not expected to be severe, according to …

When Congress passed the Affordable Care Act in 2010, its authors cited three overarching goals: improving access to health care, slowing rising medical costs, and improving health outcomes. One of the main ways to achieve these three missions was to require health insurers to provide preventive health care services at …

The US Centers for Medicare & Medicaid Services (CMS) could require states to report additional health quality data, including more behavioral health quality data. A proposed rule released late Thursday, if finalized, would require states to report behavioral health measures on the Core Set of Adult Health Care Quality Measures …

SOUTH LAKE TAHOE, Calif. — Barton Memorial Hospital has received a five-star rating from the Center for Medicare and Medicaid Services, the highest rating issued by the federal oversight agency. This national honor recognizes Barton Health’s quality measures and ongoing efforts to provide safe, quality health care to its patients. …

With a new initiative, Bristol Myers Squibb is seeking recommendations on how to better integrate people with disabilities into clinical trials. (Bristol Myers Squibb) People with disabilities are often excluded from clinical trials, which limits what is known about how new treatments will affect people with various conditions. Today, a …

Even in recent years, the average life expectancy of Americans has increased dramatically. Just a few years ago, a 75-year-old white man could only expect to live to his early 80s. Now he can expect to live to be 87. The same increased life expectancy is available to all other …

Sulfur Springs Mayor Doug Moore recently issued a proclamation designating this week as National Health Centers Week in Sulfur Springs, and encourages all Americans to participate in “celebrating the important partnership between America’s Community Health Centers and the communities they serve”. For more than 50 years, Community Health Centers have …

When Congress passed the Affordable Care Act in 2010, its authors cited three overarching goals: improving access to health care, slowing rising medical costs, and improving health outcomes. One of the main ways to achieve these three missions was to require health insurers to provide preventive health care services at …

Two Connecticut women with disabilities have sued the U.S. Department of Health and Human Services over the loss of Medicaid coverage due to a Trump administration rule change released the day after the 2020 election. As the country focused on counting votes, Medicaid administrators in every state were being ordered …

August 6—Editor’s Note: The Times Tribune is pleased to offer ‘Toni Says’, a new column featuring helpful Medicare information presented in an engaging Q&A format. Hello Tony: My husband, David, was laid off because of what’s happening to the economy and rising gas prices. He is 68 years old and …

RANCHO CUCAMONGA, CA., August 4, 2022 /PRNewswire/ — Facilitating ongoing conversations to benefit the health and well-being of its most vulnerable members, Inland Empire Health Plan (IEHP) has organized the Community Action Partnership of San Bernardino County (CAPSBC) Fourth Annual Poverty Symposium 2022 friday july 29 at his seat. The …

Ensign Group (Nasdaq: ENSG) management is confident of its future growth and financial stability at this stage of the pandemic, as occupancy rates continue to improve while labor issues are attenuating. Ensign CEO Barry Port also pointed to the most recent SNF final rule issued by the Centers for Medicare …

This new solution from Predict Health and Rex Wallace Consulting helps Medicare Advantage plans better engage Dual-Special Needs Plan (D-SNP) members, meet new Centers for Medicare & Medicaid Services (CMS) requirements, and improve their competitiveness in the market ARLINGTON, Va., August 12022 /PRNewswire/ — Predict Health, an innovative leader in …

After months of doing nothing, Democrats in Congress finally seem on the verge of achieving something – or rather, several things, from protections for same-sex marriage to tens of billions of dollars for computer chips to, finally, an economic package passed through reconciliation. There’s still room for the majority to …

(© Aquir – stock.adobe.com) Piedmont Infusion Services and its owner, Jacob Patterson, have agreed to pay $310,000 to resolve allegations that they violated the False Claims Act and the Virginia Fraud Against Taxpayers Act by submitting false bills to Medicare and Medicaid. Patterson, 66, of Danville, was a pharmacist who …

A report released last week by the Washington State Hospital Association indicates that virtually all hospitals in the state are in financial difficulty. (here) A recent survey found that hospital revenues increased by 5% from 2021 to 2022, but spending increased by 11% over the same period. It is unbearable. …

Discrepancies in regional health spending are not limited to private or public payers Researchers from Yale, Stanford and Dartmouth conducted a nationwide analysis of Medicare, Medicaid and private insurer spending over a small area, looking to see if certain areas have low spending in all three or if other factors …

QUINCY – The owner of a Quincywas sentenced to three to four years in state prison after pleading guilty to defrauding public and private insurance companies, including the state’s Medicaid program. Nicole Kasimatis48 years old, from Quincyowner of Fortitude Advice and Recovery Center in Quincypleaded guilty to Norfolk Superior Court …

Although the cancer model of care produced positive results, the value-based model of care cost Medicare money. Attention now turns to its successor, the Oncology Improvement Model. The Oncology Model of Care (OCM) was introduced in 2016 by the Centers for Medicare & Medicaid Services (CMS) with the goal of …

Securities • High Court Rules for HHS in Hospital Health Insurance Payment Disputes• Volume of healthcare services transactions down 9% in the first quarter• CMS’s Proposed Payment Rule Could Impact M&A Activity• AHA urges lawmakers to change proposed IPPS payment rule• Lawmakers introduce rural hospital support law• Hospital CEO departures …

An ounce of prevention… well, you know the rest. In medicine, prevention aims to detect problems before they become serious, affecting both a patient’s health and finances. One of the most popular parts of the Affordable Care Act, which allows patients to get certain tests or treatments without paying money …

President Joe Biden speaks on abortion access during an event in the Roosevelt Room of the White House, Friday, July 8, 2022, in Washington. Vice President Kamala Harris looks to the left. (AP Photo/Evan Vucci) By SEUNG MIN KIM, ZEKE MILLER and CHRIS MEGERIAN Associated press …

While setting higher staffing standards for nursing homes continues to be a top priority in the minds of federal leaders, few in the industry see it as a viable or sustainable path. Given the current staffing climate, with an approximately 15% decline in the long-term care workforce since the start …

WASHINGTON — Congressmen Steve Cohen (TN-09) and Jim Cooper (TN-05) today applauded the Biden administration’s Center for Medicare and Medicaid Services (CMS) for ask Tennessee to redesign major changes that would have turned Tennessee’s Medicaid program, known as TennCare, into a block grant. This demand makes it more likely that …

Pgiam/iStock via Getty Images Launch of its cover on Amedisys (NASDAQ: AMED) and Addus HomeCare (ADUS), Stifel had mixed views on the two home health care companies after the Centers for Medicare and Medicaid Services (CMS) proposed Medicare home rate reductions last week. Issuing a buy rating on Addus (ADUS), …

CORAL GABLES, Fla., June 27, 2022 (GLOBE NEWSWIRE) — MSP Recovery, Inc. (“MSP Recovery” or “MSPR”), a Medicare, Medicaid, commercial and secondary reimbursement recovery and technology leader, today provided commercial update today. MSP has begun submitting individual claims totaling more than $5.6 billion in billed amounts for payments owed by …

A Social Security Administration office in San Francisco. Getty Images A new report from Social Security trustees points to a slightly longer time horizon for the program’s trust funds. But even with a new exhaust date of 2035 – a year later than expected last year – the program still …

The Department of Health and Human Services, Office of the Inspector General (OIG) recently issued a favorable advisory opinion, OIG Advisory Opinion No. 22-11 (the “Opinion”), analyzing the proposed employment of a person excluded from federal health care programs. to perform marketing functions related to workers’ compensation (WC) programs (the …

According to a new report from Reports and Data, the global telemedicine market is expected to reach USD 565.81 billion by 2030. NEW YORK CITY, NY, USA, June 20, 2022 /EINPresswire.com/ — According to a new report from Reports and Data, the global telemedicine market is expected to reach USD …

Legislation sponsored by State Rep. Bronna Kahle to expand a reimbursement program to county medical care facilities is now law. Kahle’s bill extends the sunset on a program that reimburses county health care facilities that provide care to many Medicaid patients, according to a news release. The extension allows counties …

Policy makers would serve the nursing home industry better if they understood where and how capital markets can most effectively support the sector – namely how private financing plays a role in helping support a challenging operating environment. According to a new report compiled by ATI Advisory and commissioned by …

Accurately performing assessments and documenting patient care should be more of a priority for skilled nursing facilities in the future. Not only because operators are facing more MDS coordinator shortages and outsourcing the process as a result, but also reducing hospital stays could be a way for NFCs to capitalize …

By Susan Jaffe | Kaiser Health News The Biden administration plans to require the nation’s 15,500 nursing homes to spend most of their Medicaid payments on direct resident care and limit the amount used for operations, maintenance and capital improvements or diverted to profits. If passed, it would be the …

San DiegoVeyo-based company, which developed an Uber-style model to get Medicaid and Medicare members to doctor’s appointments, has signed a deal to sell to its rival Medical transport management of Saint Louis for an undisclosed price. The acquisition, which is not yet finalized, should bring Medical transport management annual turnover …

West Virginia Senator Joe Manchin Photo: Tom Williams/Zuma Press Progressives are still trying to get West Virginia Sen. Joe Manchin to support a partisan tax and spending bill. How rude of Medicare and Social Security administrators to interrupt this serenade with a reminder last week that entitlements are going bankrupt. …

HARRISBURG, Pa. (WHTM) — A Cumberland County man who controlled a group of local pain clinics has agreed to pay $900,000 for alleged violations of the False Claims Act. According to the United States Attorney’s Office, between 2017 and 2019, Rodney Yentzer “caused the submission of false Medicare claims” for …

Documenting face-to-face encounters remains a pain point for home care providers. It makes sense why, too. The rules and regulations surrounding it are often inconsistent, but there are also ways for providers to combat claim denials. Face-to-face documentation is already a top reason for these claim denials in Medicare and …

Henry Jones, who kept falling ill after 11 years of homelessness, was admitted in 1991 to Christ House, one of the nation’s first medical respite programs. Ryan Levi/Compromise hide caption toggle caption Ryan Levi/Compromise Henry Jones, who kept falling ill after 11 years of homelessness, was admitted in 1991 to …

Seattle – The former chief executive of the Northwest Physicians Laboratory (NWPL) was sentenced today in U.S. District Court in Seattle to two years in prison and $7.6 million in restitution for conspiring to solicit bribes, US Attorney Nick Brown said. Jae Lee, 51, of Bellevue, Washington, served as CEO …

A day after New Jersey went to court to take control of one of the worst nursing homes in the state, federal regulators unexpectedly decided to block Andover’s Woodland Behavioral and Nursing Center , long-struggling, to receive funding from Medicare and Medicaid. The decision, which could mean the death knell …

DES MOINES, Iowa, May 24, 2022 /PRNewswire/ — OpenLoop, a leader in white-label telehealth support services powering virtual care across the country, has officially exceeded 90% coverage by national insurers thanks to OpenLoop’s network of accredited clinicians. . This further drives customer success by expanding access to patient coverage in …

As patients continue to seek ways to be cared for at home rather than in more institutional settings like nursing homes, an imminent nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) model could reduce managed care relationships and move care away from NFCs. Results from a five-year demonstration of …

What you should know: – Today, Polygon Networks, a leading blockchain and scaling solution, announced a partnership with Tokenology and MSP Recovery to provide LifeChain – a new healthcare claims platform. – LifeChain will leverage blockchain technology to solve healthcare’s biggest problems, including fraud, payment inefficiencies and outdated processes. Tokenize …

America is back to work. The number of Americans forced to rely on unemployment insurance programs for support has fallen to its lowest level in more than 52 years. When I took office, there were nearly 20 million Americans on unemployment insurance to feed their families and keep a roof …

The GAO is conducting a study on telehealth. The United States Government Accountability Office (GAO) provides Congress, heads of executive agencies, and the public with timely, factual, and nonpartisan information that can be used to improve government and save taxpayers billions of dollars. For example, the GAO recently determined that …

Dear wise senior, What exactly does Medicare cover when it comes to Alzheimer’s disease? My husband was recently diagnosed with early stage Alzheimer’s disease, and we would like to know what is covered and what is not. – Plan ahead Dear Planning, I’m so sorry to hear …

Nebraska hospitals provide a $15 billion boost to the state’s economy each year. That’s according to a new study from the Nebraska Hospital Association. “Our hospitals employ 50,000 Nebraskas and pay more than $3.6 billion a year in payroll and benefits,” said Jeremy Nordquist, president of the Nebraska Hospital Association. …

As the Centers for Medicare & Medicaid Services continues its efforts to increase transparency about nursing home ownership — and with private equity in particular gaining momentum — the former head of the government agency said called some of the initiatives a “colossal waste of time”. Instead, former CMS administrator …

By Tony King Dear Tony, Ten days ago I placed my medicare mother in a “rehabilitation facility” for about three weeks, thinking her post-hospital therapy would go better there than she did. would be here at home…. WRONG…. I enrolled my poor mother in The Halls of H*ll, and now …

Are health insurance providers specific to your claims? Federal regulations require that 90% of “clean claims” be paid to health care providers within 30 days. But what if the payer doesn’t pay within 30 days? What if your claims are impure? The problem is – who determines what a clean …

Government officials and disability advocates are preparing for a possible end to the public health emergency. (Brian Cassella/Chicago Tribune/TNS) As attention on COVID-19 fades and the federal government considers ending the pandemic-triggered state of emergency, officials are warning big changes are coming for some disability programs. Currently, the nation is …

Unsplash.com photo by Hush Naidoo Jade Photography. In light of recent federal policy changes, Sen. Mary L. Washington (D-Baltimore City) and Congresswoman Anne R. Kaiser (D-Montgomery) are urging the Department of Health to rethink its Medicaid health care policy for transgender people in Maryland. Washington and Kaiser wrote to Maryland …

Each year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered by the program, federal investigators concluded in a report released Thursday. Investigators urged Medicare officials to step up oversight of these private insurance plans, which provide benefits to 28 …

Editor’s note: This article was originally published on Thursday, April 21, 2022. GREAT NECK, NY — A Long Island cardiologist was indicted Tuesday on federal charges, accused of defrauding Medicare and Medicaid of more than $1.3 million during the COVID-19 pandemic. Federal prosecutors say Perry Frankel — owner and operator …

With more attention than ever on home care, there are a number of legislative and regulatory developments that will be essential for providers to stay informed. For providers like Help at Home, which works in the Medicaid space on private pay, the short-term gains are obvious. “If you take what’s …

To punch holes in Medicare audits, you need to know the rules. I’d like to write today about the sheer absurdity of how these Recovery Audit Contractor (RAC), Area Program Integrity Contractor (ZPIC), Medicare Administrative Contractor (MAC) and other types audits are held against health care providers. When an auditor …

Growing numbers of American seniors are adding a touch of green to their golden years as more states legalize marijuana for medical or recreational use and cannabis companies conduct outreach to communities of people elderly to educate potential patients and caregivers about the potential benefits. Newsletter Sign-Up Retirement Barron’s brings …

Marilyn Long, left, helps her brother, Jeff Malanoski, who has Down syndrome and Alzheimer’s disease, at their home in Elk Grove Village, Illinois in 2014. (Chris Walker/Chicago Tribune/TNS) After complaints of discrimination, federal authorities are scrapping a plan that would have prevented people with Down syndrome from accessing a new …

Over the past 10 years, the Medicare system has attempted to improve the quality of health care received by millions of older Americans, while slowing rising costs to the federal budget, by encouraging health care providers to join Responsible Care Organizations (ACOs). Today, ACOs coordinate care for 11 million people, …

By NICHOLAS K. GERANIOS, Associated Press SPOKANE, Wash. (AP) — Providence Health & Services Washington has agreed to pay $22.6 million to resolve allegations that its Walla Walla hospital fraudulently billed Medicare, Medicaid and other federal health care programs for medically unnecessary neurosurgical procedures, prosecutors said Tuesday. Vanessa R. Waldref, …

A new study led by Susan G. Komen® The researchers indicate that patients diagnosed with de novo stage 4 breast cancer – also called metastatic breast cancer – had improved survival rates and decreased death rates when these patients had access to care. de novo means the breast cancer was …

TAMPA, Fla. (WFLA) — Your tax dollars pay to get Medicare and Medicaid beneficiaries to critical medical appointments, but, for some, those trips never happen. Missing these doctor visits can have disastrous consequences. We’re not just talking about health checks. A Tampa Bay-area woman says the problem is now delaying …

Three presentations offered on Thursdays in April – The Health Insurance Advisory and Advocacy Program (HICAP) will sponsor free virtual presentations for those interested in better understanding Medicare benefits. Understanding Medicare presentations will take place: • Thursday 14 April, at 12 noon• Thursday 21 April, at 2 p.m.• Thursday 28 …

I’ve read a lot of columns recently that begin with the phrase, “If there’s one hard lesson we’ve learned from the pandemic…”. Well, this is not one of those columns, because I’m sure we’ve learned a lot of hard lessons that we should all reflect on and not repeat. Instead, …