Tag:medicare
DOJ Joins Whistleblower Suit Against UnitedHealth Group
The United States Department of Justice (“DOJ”) recently intervened in a qui tam action against UnitedHealth Group (“United”) and its subsidiary, UnitedHealthcare Medicare & Retirement, the nation’s largest provider of Medicare Advantage (“MA”) Plans. The suit alleges that United engaged in an “up-coding” scheme to receive higher payments than they should have under MA’s risk adjustment program. Assuming these allegations of United’s false claims are true, then United billed and received hundreds of millions of dollars in improper payments from Medicare.
Mother and Son Sentenced to Federal Prison for Pharmacy Fraud Scheme
Anais Holland-Rudd Associate Editor Loyola University Chicago School of Law, JD 2018 Niurka Fernandez, 54, and her son Roberto Alvarez, 26, both plead guilty on August 31, 2016 to one count of conspiracy to commit health care fraud. On November 10th, Fernandez was sentenced to 120 months in prison while Alvarez was sentenced to …
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MACRA 101: Noteworthy Changes in the Final Rule
Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017 As our MACRA 101 series comes to an end, this article is intended to point out key differences between the proposed rule released earlier this year and the final rule which was released October 14th. The lengthy final rule, reaching almost 2,400 …
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MACRA 101: Advanced Alternative Payment Models
Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018 The Quality Payment Program (QPP) will reward delivery of quality patient care through the following two programs: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). These two programs will allow clinicians and physicians to provide care in a …
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MACRA 101: MIPS and the Clinical Practice Improvement Reporting Category
Christine Bulgozdi Associate Editor Loyola University Chicago School of Law, JD 2018 The Merit-based Incentive Payment System (“MIPS”) is one of the two different payment methods that MACRA will use for eligible clinicians. Clinicians will be evaluated based on a single Composite Performance Score from four reporting categories: Quality, Resource Use, Advancing Care Information and …
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MACRA 101: MIPS and the Advancing Care Information Category
Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017 This article will spell out the details for the Advancing Care Information (ACI) category of the Merit Based Incentive Payment System (MIPS). This category accounts for 25% of a clinician’s overall composite score and is intended to replace the current Meaningful Use …
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MACRA 101: MIPS and the Resource Use Category
Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018 As previously discussed, MIPS will streamline Medicare’s current quality measures into one composite score from four reporting categories: Quality, Resource Use, Advancing Care Information, and Clinical Practice Improvement. This score will then be used to determine the reimbursement to a clinician based …
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MACRA 101: MIPS and the Quality Reporting Category
Christine Bulgozdi Associate Editor Loyola University Chicago School of Law, JD 2018 The Merit-based Incentive Payment System (“MIPS”) is one of the two different payment methods that MACRA will use for eligible clinicians. MIPS replaces the existing fee-for-service model and is expected to be the payment track that most clinicians take. Clinicians will be evaluated …
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Understanding Medicare Documentation Requirements
Brittany Tomkies Executive Editor Loyola University Chicago School of Law, JD 2017 With more than one billion claims processed annually by the Medicare Fee-For Service (FFS) Program for more than one million health care professionals, understanding and identifying common errors encountered by Medicare Administrative Contractors (MACs) and other contractors such as Recovery Auditors (RACs) …
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MACRA 101: Physician Fee Schedule Adjustments and the New Pick Your Pace Options
Alanna J. Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017 In this article, we will cover the anticipated reimbursement scheme for both MIPS and APMs, as well as briefly discuss two new reporting paths recently revealed to be available to clinicians in 2017. One of the most attractive pieces of the …
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