Report on Medicare Compliance 29, no. 23 (June 22, 2020):
- CMS has created a new point of origin (PoO) code, G, to indicate a transfer from a designated disaster alternative care site (ACS) because of changes in connection...more
Report on Medicare Compliance 29, no. 23 (June 22, 2020):
The HHS Departmental Appeals Board (DAB) has upheld the largest stipulated penalty imposed by the HHS Office of Inspector General (OIG) in years. OIG fined...more
Report on Medicare Compliance Volume 29, no. 22 (June 15, 2020):
- The HHS Office of Inspector General has updated its Work Plan, and new items include opioid treatment challenges during the COVID-19 pandemic.
- In a...more
6/19/2020
/ Audits ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Opioid ,
Overpayment ,
Work Plans
Report on Medicare Compliance 29, no. 21 (June 8, 2020) -
The HHS Office of Inspector General (OIG) has released its Semiannual Report to Congress, which covers Oct. 1, 2019, through March 31, 2020. During this period, OIG...more
Report on Medicare Compliance 29, no. 21 (June 8, 2020) -
Whether an organization shows its commitment to compliance with dollars is a new focus of the second update to guidance on evaluating compliance programs from the...more
Report on Medicare Compliance 29, no. 20 (June 1, 2020) -
The HHS Office of Inspector General (OIG) has unveiled its “OIG Strategic Plan: Oversight of COVID-19 Response and Recovery.” Its goals are protecting people, funds...more
6/2/2020
/ Civil Monetary Penalty ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
OIG ,
Physicians ,
Settlement
Report on Medicare Compliance 29, no. 18 (May 11, 2020)
- The HHS Office for Civil Rights has posted guidance reminding providers that “the COVID-19 public health emergency does not alter the HIPAA Privacy Rule’s existing...more
5/16/2020
/ Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Electronic Protected Health Information (ePHI) ,
False Accusations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hiring & Firing ,
Medicare ,
Nurses ,
OCR ,
Patient Privacy Rights ,
PHI ,
Professional Associations ,
Public Health Emergency ,
Retaliation ,
Unions ,
Workplace Safety
Report on Medicare Compliance 29, no. 18 (May 11, 2020) -
The gyms and dorm rooms at Sonoma State University in California are an alternate care site for St. Joseph Health System in Santa Rosa and other health care...more
Report on Medicare Compliance 29, no. 16 (April 27, 2020)
- The HHS Office of Inspector General (OIG) has proposed a rule on civil monetary penalties (CMPs) for information blocking and fraud related to HHS grants, contracts...more
5/5/2020
/ Audits ,
Billing Errors ,
Civil Monetary Penalty ,
Compliance ,
Data Blocking ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Fraud ,
Kickbacks ,
Medicare ,
Medicare Billing Privileges ,
OIG ,
Physicians ,
Psychological Counseling ,
State Attorneys General ,
Telehealth
Report on Medicare Compliance 29, no. 16 (April 27, 2020) -
Because of the coronavirus, the talents of a business development executive at a hospital are wasted, and the chief financial officer (CFO) is wondering whether...more
5/2/2020
/ CARES Act ,
CFOs ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Federal Grants ,
Health Care Providers ,
Healthcare Facilities ,
Hospitals ,
Medicare ,
Provider Relief Fund ,
Public Health Emergency ,
Relief Measures ,
Risk Assessment ,
Risk Mitigation ,
Terms and Conditions
Report on Medicare Compliance 29, no. 15 (April 20, 2020)
- Maury Regional Medical Center in Tennessee has agreed to pay $1.7 million to settle false claims allegations over MS-DRG coding, the U.S. Attorney’s Office for...more
4/29/2020
/ Civil Monetary Penalty ,
Compliance ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Hospitals ,
Laboratories ,
Medicaid ,
Medical Coding ,
Medicare ,
OIG ,
Overpayment ,
Settlement Agreements ,
TRICARE ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 29, no. 13 (April 6, 2020)
- During the coronavirus pandemic, the HHS Office of Inspector General (OIG) is “trying to minimize the burdens on providers,” said Christi Grimm, principal deputy...more
4/20/2020
/ Compliance ,
Coronavirus/COVID-19 ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
HIPAA Privacy Rule ,
Hospitals ,
Medicare ,
OCR ,
OIG ,
Overpayment Recovery Time Limits ,
Unduly Burdensome
Report on Medicare Compliance 29, no. 12 (March 30, 2020)
In a March 26 email, CMS said hospitals have flexibility to deliver Medicare notices to patients with suspected or confirmed cases of COVID-19. “Hard copies of...more
Report on Medicare Compliance 29, no. 12 (March 30, 2020)
A federal court on March 24 ordered CMS to let Medicare patients “challenge decisions by hospitals” to change their status from inpatients to observation, dating...more
4/7/2020
/ Administrative Procedure Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Class Action ,
Compliance ,
Due Process ,
Inpatient Billing ,
Medicare ,
Medicare Act ,
Medicare Beneficiaries ,
Medicare Outpatient Observation Notice (MOON) ,
Medicare Part A ,
Right To Appeal ,
Skilled Nursing Facility
Report on Medicare Compliance 29, no. 11 (March 23, 2020)
- There are signs of life to the national hospital reviews of short stays and high-weighted MS-DRGs (HWDRGs). A CMS spokesperson said Avar Consulting, a...more
Report on Medicare Compliance 29, no. 10 (March 16, 2020) -
? Millennium Physicians Association PLLC, which owns two sleep centers in the Houston area, has paid $1,248,964 to settle false claims allegations over sleep...more
Report on Medicare Compliance 29, no. 10 (March 16, 2020) -
Even as it warned hospitals they must comply with the screening and transfer requirements of the Emergency Medical Treatment and Labor Act (EMTALA) in the...more
Report on Medicare Compliance 29, no. 7 (February 24, 2020)
- Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more
2/28/2020
/ Acute Facilities ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Elder Care ,
False Claims Act (FCA) ,
Health Care Providers ,
MACs ,
Medicare ,
OIG ,
Provider Payments ,
Recoupment ,
Settlement ,
Skilled Nursing Facility ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 29, no. 6 (February 17, 2020) -
Tenet Healthcare Corp. and an affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.41 million to settle False Claims Act (FCA)...more
2/19/2020
/ Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Hospitals ,
Kickbacks ,
Medicaid ,
Medical Equipment ,
Medicare ,
Physicians ,
Settlement ,
TRICARE ,
Unnecessary Medical Procedures ,
Whistleblowers
Report on Medicare Compliance 29, no. 5 (February 10, 2020)
- David Laufer, the former chief of the Prosthetics and Orthotics Department at Walter Reed National Military Medical Center in Bethesda, Maryland, was charged...more
2/18/2020
/ Compliance ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Failure To Disclose ,
False Accusations ,
False Statements ,
FBI ,
Fraud ,
Gifts ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Supplies ,
Medicare ,
Patient Privacy Rights ,
Retaliation ,
Whistleblowers ,
White Collar Crimes
Report on Medicare Compliance 29, no. 5 (February 10, 2020) -
At least two Medicare administrative contractors (MACs) have set their sights on observation services, and there may be more to come. WPS is auditing...more
Report on Medicare Compliance 29, no. 4 (February 3, 2020) -
? Central Coast Inpatient Consultants Inc. in California has agreed to pay $750,000 in a civil monetary penalty settlement with the HHS Office of Inspector...more
2/6/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Compliance ,
Enforcement Actions ,
False Claims Act (FCA) ,
HCPCS ,
Health Care Providers ,
Medicare ,
Medicare Billing Privileges ,
Medicare Fraud ,
Medicare Provider Agreements ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Restitution ,
Settlement
Report on Medicare Compliance 29, no. 3 (January 27, 2020) -
Mission, Texas, rheumatologist Jorge Zamora-Quezada, M.D., was found guilty by a jury Jan. 15 for his part in a $325 million heath fraud scheme in which he...more
1/30/2020
/ Bodily Injury ,
Centers for Medicare & Medicaid Services (CMS) ,
Chiropractors ,
Compliance ,
Criminal Convictions ,
Emotional Injury Claims ,
False Billing ,
False Claims Act (FCA) ,
False Statements ,
Final Rules ,
Guilty Pleas ,
Healthcare Fraud ,
Medicare ,
Nursing Homes ,
Pain Management ,
Physicians
Report on Medicare Compliance 29, no. 2 (January 20, 2020) -
- The HHS Office of Inspector General has updated its Work Plan, which includes an item on early discharges from inpatient rehabilitation facilities to home...more
1/27/2020
/ Civil Monetary Penalty ,
Compliance ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Medicare Fraud ,
OIG ,
Psychiatrists ,
Settlement ,
TRICARE ,
Whistleblowers
Report on Medicare Compliance 29, no. 1 (January 13, 2020) -
The Department of Justice (DOJ) said Jan. 7 it has filed a False Claims Act lawsuit against Community Health Network, an integrated health care system in central...more