September 13, 2022 Transgender beneficiaries sue Florida over Medicaid limit September 8, 2022 Medicaid extensions for new moms grow, may run into limits September 5, 2022 Prosecutors: $130K settlement in Medicaid False Claims Act September 2, 2022 Judge dismisses official’s lawsuit agai...
Providing benefits to which the patients or participants who receive them are not eligible, by means of fraud or deception, or by not correctly reporting assets, income, or other financial information. Filing claims for reimbursement to which the claimant is not legitimately entitled. Committing iden...
Florida Medicaid investigators are latest to ask Medco for contracts, claimsLEWIS KRAUSKOPF, STAFF WRITER
Established through Medicare regulations, the upper payment limit restricts the amount of money a state is allowed to pay for Medicare claims. The Upper Payment Limit (UPL) is determined by the types of providers and the services provided. 87...
During a routine check by HHS' Office of Inspector General, which investigates Medicare and Medicaid fraud, special agents in Florida noticed that a local company had recently changed owners and had another address in their building. But that location didn't have any actual employees. It was n...
In February, Georgia officials were discussing a high-priority change request to resolve an ongoing problem: A defect affected potentially tens of thousands of “cases/claims” for families in the Supplemental Nutrition Assistance Program, known asSNAP, and the Temporary Assistance for Needy Families ...
9,10 Potential reasons for the low provider participation in MMC include low reimbursement rates and the administrative burden associated with billing, contracting, and addressing claims denials and delayed reimbursements.42-47 Additionally, MH provider shortages can make adhering to NAS particularly ...
Since our initial review was limited to administrative cost claims, you requested that we expand our analysis of state practices regarding Medicaid reimbursement of school-based administrative activities and address as well the use of “bundled” rates for school-based services. ...
(46)If NDMS funds -- and, if enacted, funds made available through the budget reconciliation conference agreement are insufficient to cover the costs associated with state claims submitted under the uncompensated care pools -- it is unclear whether additional steps may be taken by the Secretary ...
ABA also said Point32 stopped paying for medical claims “without significant justification.” “We believe this lawsuit is necessary to attempt to halt the irresponsible and unreasonable behavior by Point32,” said Christopher Barnett, founder of ABA Centers, in a statement. “We have tried for ...