Posts Tagged ‘CMS’
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 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 MoreWhy Your Pharmacy Claim Might be Denied After Oct. 1
Effective this Friday, Oct. 1, fee-for-service pharmacy claims must include prescribers National Provider Identifier (NPI) and the prescribers must be actively enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b) or your claims will be denied. Beginning in March, Florida Medicaid, a division of the Agency for Health Care…
Read MoreUnitedHealthcare Loses MA Overpayment Case
A federal appeals court recently ruled against UnitedHealthcare, reversing a 2018 decision involving Medicare Advantage overpayments and sending the case back to the lower court with instructions to rule in favor of the Centers for Medicare & Medicaid Services (CMS). The lower court’s ruling in UnitedHealthcare Insurance Co. v. Azar, No. 16-157 (D.D.C.), vacated Medicare’s…
Read MoreFeds Recover $3.1B in FY 2020 Resulting From Healthcare Fraud Investigations
The federal government recouped nearly $3.1 billion last year following investigations into healthcare fraud, according to a new report released by the U.S. Department of Health and Human Services and the Department of Justice. The annual report noted that DOJ opened 1,148 new criminal healthcare fraud investigations in 2020, filing criminal charges in 412 cases…
Read MoreCMS Proposes Permanently Covering Audio-Only Telehealth for Mental Health Services
The Centers for Medicare & Medicaid Services (CMS) recently released its proposed 2022 Physician Fee Schedule, which includes payment rates for Medicare next year, as well as several other policy proposals that might impact physicians. Among them, CMS wants to make permanent Medicare coverage of audio-only mental health services via telehealth. Many patients until now…
Read MoreAs Telehealth Use Skyrockets CMS Expands Payment List
The Centers for Medicare & Medicaid Services (CMS) recently announced that more than 34.5 million services were delivered via telehealth to patients in Medicare and the Children’s Health Insurance Program (CHIP) from March through June. That equates to an approximately 2,632 percent jump compared to the same period in 2019. However, CMS noted that since…
Read MoreChanges to Nursing Home Star Ratings Are Here
Beginning this month, the Centers for Medicare & Medicaid (CMS) is changing its star ratings on Nursing Home Compare and its Five-Star Quality Rating System, which allows consumers to compare quality between nursing homes. CMS says the updates “reflect more transparent and meaningful information about the quality of care that each nursing home is giving…
Read MoreGroundbreaking Rules for Electronic Health Records Proposed
The U.S. Department of Health and Human Services is proposing new rules that could pave the way for increased exchange of healthcare data by 2020. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would allow patients to have access…
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