Community Health Network (CHN) in Indiana has agreed to pay $345 million to settle false claims allegations that it paid over-the-top salaries to hundreds of physicians and rewarded them for their referrals in violation of...more
2/20/2024
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
Compensation ,
Competition ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Employment Contract ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
OIG ,
Physicians ,
Stark Law ,
Whistleblowers
H. Lee Moffitt Cancer Center & Research Institute Hospital Inc. in Tampa, Florida, has agreed to pay $19.564 million to settle false claims allegations over claims submitted to federal health care programs for items and...more
2/20/2024
/ Clinical Trials ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
HIPAA Privacy Rule ,
Medical Records ,
Medicare ,
OCR ,
Provider Self-Disclosure Protocol ,
Settlement
In a case that may hit a raw compliance nerve, Ascension Macomb Oakland Hospital in Michigan has agreed to pay $100,000 in a settlement with the HHS Office of Inspector General (OIG) over free services provided to certain...more
1/31/2024
/ Anti-Kickback Statute ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Litigation Strategies ,
OIG ,
Popular ,
Self-Disclosure Requirements ,
Settlement ,
Stark Law
Hospitals and other providers should brace for recoupment of possibly hundreds of millions of dollars they were reportedly overpaid for services provided under the COVID-19 uninsured program (UIP) in the wake of new audit...more
8/17/2023
/ Audits ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
HRSA ,
OIG ,
Overpayment ,
Provider Relief Fund ,
Relief Measures ,
Whistleblower Awards ,
Whistleblowers
Report on Medicare Compliance Volume 32, no 25 (July 2023)
The former chief hospital executive of Bayonne Medical Center (BMC) in New Jersey has filed a False Claims Act (FCA) lawsuit alleging the hospital and two others...more
7/18/2023
/ CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
HRSA ,
Overpayment ,
Provider Relief Fund ,
Whistleblowers
Report on Medicare Compliance Volume 32, no 25 (July 2023)
Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional...more
7/18/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
False Billing ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Hospice ,
Medicaid ,
Medicare ,
Physicians ,
Settlement
In what passes for neon lights in the regulatory world, CMS said Medicare Advantage (MA) plans must follow the two-midnight rule, its case-by-case exception and the inpatient-only (IPO) list, according to the final 2024 rule...more
4/10/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Hospitals ,
Local Coverage Determination (LCD) ,
MACs ,
Medicare ,
Medicare Advantage ,
Two-Midnight Rule
A proposed HHS regulation on the Confidentiality of Substance Use Disorder (SUD) Patient Records under 42 C.F.R. Part 2 would bring it further in line with HIPAA, which is somewhat of a double-edged sword, attorneys say....more
12/6/2022
/ Breach Notification Rule ,
Confidentiality Policies ,
Consent ,
Criminal Penalties ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Federal Register ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Records ,
Notice of Privacy Practices ,
Personally Identifiable Information ,
Proposed Regulation ,
Proposed Rules
Report on Medicare Compliance 31, no. 35 (September 26, 2022)
- The HHS Office of Inspector General (OIG) on Sept. 23 unveiled a new template for requesting advisory opinions.
- In a new report, OIG said CMS edits...more
Report on Medicare Compliance 31, no. 35 (September 26, 2022) -
For the third time in about 2 1/2 years, hospitals or other providers that are part of Dartmouth-Hitchcock Health, a large health system in New Hampshire,...more
9/29/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Diagnostic Tests ,
False Billing ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
OIG ,
Overpayment ,
Physicians ,
Settlement ,
TRICARE
Report on Medicare Compliance 31 no. 18 (May 16, 2022)
- In a new report, the HHS Office of Inspector General (OIG) said 25% of Medicare beneficiaries experienced patient harm (adverse events and temporary harm events)...more
5/18/2022
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Home Health Care ,
Hospitals ,
Medicare ,
Medicare Beneficiaries ,
OIG ,
Patient Safety ,
Settlement
Report on Medicare Compliance 31 no. 18 (May 16, 2022) -
In a version of the future that hopefully never comes, malware is able to remove malignant-looking tumors from CT or MRI scans before they were reviewed by...more
5/17/2022
/ Connected Items ,
Cyber Attacks ,
Cyber Crimes ,
Cyber Threats ,
Cybersecurity ,
Data Collection ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Hackers ,
Health Care Providers ,
Health Technology ,
Hospitals ,
Malware ,
Medical Devices ,
Popular ,
Ransomware ,
Risk Mitigation
Report on Medicare Compliance 31, no. 14 (April 18, 2022) -
Michigan gynecologic oncologist Vinay Malviya, M.D., has agreed to pay $775,000 to settle false claims allegations in connection with medically unnecessary...more
4/20/2022
/ Audits ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medicaid ,
OIG ,
Physicians ,
Settlement Agreements ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 31, no. 14 (April 18, 2022) -
The Department of Justice (DOJ) said April 11 it has intervened in a whistleblower lawsuit against Methodist Le Bonheur Healthcare (MLH) in Memphis, Tennessee,...more
Report on Medicare Compliance 31, no. 9 (March 14, 2022) -
A federal jury on March 8 convicted New Jersey rheumatologist Alice Chu for defrauding Medicare and other health insurance programs, the Department of Justice...more
Report on Medicare Compliance 31, no. 9 (March 14, 2022) -
Congress has given telehealth services a new lease on life, at least for five months beyond the end of the COVID-19 public health emergency (PHE), in the $1.5...more
Report on Medicare Compliance 31, no. 2 (January 17, 2022) -
Thomas Jefferson University Hospitals Inc., an academic medical center in Philadelphia, Pennsylvania, has entered into a settlement with the HHS Office of...more
Report on Medicare Compliance 30, no. 32 (September 13, 2021) -
Saint Francis Medical Center in Missouri agreed to pay $1.625 million in a civil settlement of allegations it violated the Controlled Substances Act, the...more
9/17/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Controlled Substances ,
Controlled Substances Act ,
Coronavirus/COVID-19 ,
Employer Mandates ,
FBI ,
Government Investigations ,
Health Care Providers ,
Healthcare Workers ,
Hospitals ,
Medicaid ,
Medicare ,
Opioid ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Phishing Scams ,
Physicians ,
Prescription Drugs ,
Ransomware ,
Vaccinations
Report on Medicare Compliance 30, no. 32 (September 13, 2021) -
John Peter Smith (JPS) Hospital in Fort Worth, Texas, agreed to pay $3.3 million to settle false claims allegations in a case with a hot risk area, a...more
9/16/2021
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Overpayment ,
Personal Liability ,
Physicians ,
Settlement Agreements ,
Whistleblowers
Report on Medicare Compliance 30, no. 28 (August 2, 2021) -
CMS has not fined any hospitals yet for noncompliance with price transparency requirements, a spokesperson tells RMC. “In April 2021, CMS began issuing warning...more
8/5/2021
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Corrective Action Plans (CAPs) ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Noncompliance ,
Outpatient Prospective Payment System (OPPS) ,
Price Transparency ,
Warning Letters
Report on Medicare Compliance 30, no. 28 (August 2, 2021) -
When a hospital realized it had been billing for annual wellness visits without documentation of opioid and substance use screening, it wasn’t a heavy lift to...more
8/4/2021
/ 60-Day Rule ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Overpayment ,
Physicians ,
Provider Self-Disclosure Protocol
Report on Medicare Compliance 30, no. 22 (June 14, 2021) -
CMS’ supplemental medical review contractor (SMRC) is now doing postpayment reviews of Medicare claims for electrodiagnostic (EDX) testing axial muscles and...more
6/17/2021
/ Anti-Kickback Statute ,
Bribery ,
Centers for Medicare & Medicaid Services (CMS) ,
Criminal Conspiracy ,
Guilty Pleas ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
SMRC
Report on Medicare Compliance 30, no. 22 (June 14, 2021) -
A Colorado radiation therapy provider has agreed to pay $3.569 million in a civil monetary penalty settlement with the HHS Office of Inspector General...more
6/16/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
False Billing ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medical Billing Codes ,
Medicare ,
OIG ,
Overpayment ,
Physicians ,
Settlement Agreements
Report on Medicare Compliance 30, no. 17 (May 3, 2021) -
In a new provider compliance audit, the HHS Office of Inspector General (OIG) said Visiting Nurse Association of Maryland (VNA) received overpayments of $2.1...more
5/6/2021
/ Audits ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Health Care Providers ,
Medicaid ,
Medicare ,
OIG ,
Overpayment
Report on Medicare Compliance 30, no. 17 (May 3, 2021) -
With the pandemic in its second year, coding and documentation of long-haul COVID-19 patients who are admitted or readmitted to the hospital may be a sleeper risk....more