Posts Tagged ‘Centers for Medicare & Medicaid Services’
Miami Medical Coder Charged in Medicare Advantage Fraud Scheme
A Miami woman recently was charged for her role in a long-running Medicare Advantage fraud scheme to defraud Medicare out of tens of millions of dollars. Kenia Valle Boza, the former director of Medicare Risk Adjustment Analytics at HealthSun, was indicted in Miami federal court for allegedly orchestrating a scheme to submit false and fraudulent…
Read MoreCigna to Pay $173M to Settle False Claims Act Litigation Filed by Whistleblower
Health insurance giant Cigna agreed to pay nearly $173 million to resolve allegations it violated the False Claims Act by knowingly submitting false diagnosis codes under the federal Medicare Advantage program to increase its payments. In a lawsuit filed last year, the feds alleged that between 2014 and 2019, Cigna submitted to the Centers for…
Read MoreHHS-OIG Details Successes of Efforts to Curb Healthcare Fraud and Abuse in Semiannual Report to Congress
The U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) recently released its Semiannual Report to Congress touting its many successes but also adding that a lack of funding has resulted in an inability to go after even more healthcare fraud and abuse. “We are turning down 300 to 400 viable…
Read MoreStates Benefit from Multimillion-Dollar FCA Urine Test Lab Settlement
Several states are now benefiting from a multimillion-dollar settlement agreement signed late last year by a Nevada clinical lab and two of its owners who were charged with submitting false claims for payment to federal healthcare programs. Nevada Attorney General Aaron D. Ford recently announced that his state would receive $335,000 of the settlement money…
Read MoreCOVID-19 Vaccine Requirements Expanded for Healthcare Industry
By now you may have heard that President Joe Biden announced a six-prong Covid-19 action plan designed to combat the virus and the overwhelming impact of the Delta variant. Among them: staff at all Medicare- and Medicaid-certified facilities will be required to receive the COVID-19 vaccine. The Centers for Medicare & Medicaid Services, along with…
Read MoreCMS Program to Give Providers Access to Medicare Patient Data
In an effort to accelerate the transformation of the nation’s healthcare system to one that is value-based, the Centers for Medicare & Medicaid Services (CMS), recently launched the Data at the Point of Care (DPC) pilot program. The pilot program, announced by CMS Administrator Seema Verma during a Blue Button Developer Conference, will give healthcare…
Read MoreCMS Issues Proposed Rules for Rehab and Skilled Nursing Facilities
On April 17, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would update Medicare payment policies for Medicare Inpatient Rehabilitation Facilities (IRF). Two days later, on April 19, CMS issued another proposed rule, this one updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs). Let’s start…
Read MoreCMS Proposes Changes Designed to Speed up Medicare Appeals Process
It’s been a while since we last updated you on the latest about the Medicare appeals backlog, which although it has decreased some, remains troublesome. To further address the issue, The Centers for Medicare & Medicaid recently proposed revising its rules that govern the appeals process in an effort to further streamline it and reduce…
Read MoreCMS to Ease HHA, Ambulance Enrollment Restrictions
The Centers for Medicare & Medicaid Services (CMS) will ease restrictions it imposed on the enrollment of new home health and non-emergency ambulance providers in six states. In a notice that appeared in the Aug. 20 issue of the Federal Register, CMS announced that providers will be able to apply for a waiver to the…
Read MoreCMS Issues Guidance on When a Hospital is a Hospital
Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now…
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