Every health care provider has “credit balances,” which occur when a provider receives more money than it is owed for services rendered. Credit balances can be caused by a number of factors, including incorrect coding,...more
HELPFUL HINTS -
Justice Department Reports More Than $8B In Alleged Fraud Related to COVID-19 Relief Programs -
The Washington Post reports, “Since the U.S. government first marshaled its historic economic response...more
3/17/2022
/ Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Infectious Diseases ,
Medicare ,
Surprise Medical Bills ,
Telehealth
Helpful hints -
OIG Updates Health Care Fraud Self-Disclosure Protocol (“SDP”) -
On November 8, 2021, the OIG issued an updated SDP to providers, which included clarifications of existing guidance and increased the minimum...more
11/16/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Disproportionate Share Adjustments ,
Employer Mandates ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Physician Fee Schedule ,
Self-Disclosure Requirements ,
Vaccinations
On October 9, 2019, the Centers for Medicare and Medicaid Services (“CMS”) proposed sweeping changes to the federal Physician Self-Referral Law, commonly referred to as the Stark Law. While many of the changes reflect CMS’...more
12/30/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Physician Compensation Arrangements ,
Physicians ,
Regulatory Reform ,
Regulatory Requirements ,
Rulemaking Process ,
Stark Law
If the 2017 healthcare environment could be summed up in one word, it would be “uncertainty.” With the largely unexpected election of Donald Trump as President, the multiple, unsuccessful attempts by the Republican controlled...more
12/18/2017
/ Affordable Care Act ,
Bundled Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Opioid ,
Pain Management Clinics ,
Physicians ,
Trump Administration
Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more
12/12/2016
/ 60-Day Rule ,
Affordable Care Act ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Data Breach ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Fraud ,
HIPAA Breach ,
Hospitals ,
Implied Certification ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
OIG ,
Overpayment Recovery Time Limits ,
PHI ,
Physicians ,
Popular ,
Premiums ,
Provider Payments ,
Quality Payment Program (QPP) ,
Trump Administration ,
Universal Health Services Inc v United States ex rel Escobar ,
Value-Based Payments
In 2015, ICD-10 finally became a reality, and the dire predictions of problems seem to be wrong. Providers now have codes to describe just about every conceivable (and a few simply bizarre) medical occurrences. If a patient...more
Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more
12/12/2013
/ Affordable Care Act ,
False Claims Act (FCA) ,
Fraud ,
Health Insurance Exchanges ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Reform ,
Healthcare.gov ,
ICD Codes ,
MCOs ,
Medicaid ,
Medicare ,
OIG ,
Physician Medicare Reimbursements ,
Physician-Owned Distributors