Report on Medicare Compliance 30, no. 15 (April 19, 2021) -
CMS’s supplemental medical review contractor (SMRC) has added outpatient therapy claims to its list of postpayment reviews, according to its website. The SMRC,...more
4/22/2021
/ BFCC-QIOs ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
HRSA ,
Medicaid ,
Medicare ,
OIG ,
Physicians ,
Skilled Nursing Facility ,
SMRC ,
Vaccinations ,
Work Plans
Report on Medicare Compliance 30, no. 14 (April 12, 2021) -
Doctors Care P.A., the largest urgent care provider network in South Carolina, and its management company, UCI Medical Affiliates of South Carolina Inc., will...more
4/15/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Medicaid ,
Medicare ,
Proposed Regulation ,
TRICARE ,
Urgent Care Facilities ,
Whistleblowers
Report on Medicare Compliance 30, no. 14 (April 12, 2021) -
When employees are required to show their employers proof of a positive COVID-19 test before they get sick leave or a vaccination before returning to work, the...more
4/14/2021
/ Coronavirus/COVID-19 ,
Data Privacy ,
Data Protection ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Records ,
Mobile Apps ,
Privacy Laws
Report on Medicare Compliance 30, no. 13 (April 5, 2021) -
Because of the COVID-19 pandemic, CMS said April 1 that it won’t update the 855 enrollment form with sections on “affiliation disclosures,” as planned in a 2019...more
Report on Medicare Compliance 30, no. 11 (March 22, 2021) -
University Medical Center of Southern Nevada has agreed to pay $128,820 in a civil monetary penalty settlement that stemmed from a self-disclosure. According to...more
3/24/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medical Billing Codes ,
Medicare ,
Medicare Beneficiaries ,
MedPAC ,
OIG ,
Physicians ,
Public Health Emergency ,
Settlement Agreements ,
Telehealth
Report on Medicare Compliance 30, no. 11 (March 22, 2021) -
A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more
3/23/2021
/ Administrative Law Judge (ALJ) ,
Appeals ,
Billing Errors ,
Civil Monetary Penalty ,
False Claims Act (FCA) ,
Health Care Providers ,
Medicare ,
Medicare Part B ,
Medicare Prescription Drug Improvement and Modernization Act (MMA) ,
Overpayment ,
Physicians ,
Settlement
Report on Medicare Compliance 30, no. 8 (March 1, 2021) -
According to a CMS spokesperson, “CMS has not yet determined when Targeted Probe and Educate reviews will resume.” Meanwhile, “CMS continues to temporarily pause...more
3/2/2021
/ Bad Debt ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
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Elder Care ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Facilities ,
Home Health Care ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medicare ,
Medicare Beneficiaries ,
Medicare Part A ,
Noncompliance ,
OIG ,
Physician Medicare Reimbursements ,
Physicians ,
Settlement Agreements ,
Skilled Nursing Facility
Report on Medicare Compliance 30, no. 8 (March 1, 2021) -
After the 2021 Medicare Physician Fee Schedule extended coverage of many telehealth services until the end of the public health emergency (PHE), including...more
3/2/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Denial of Insurance Coverage ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Medicare ,
Physician Fee Schedule ,
Physician Medicare Reimbursements ,
Physicians ,
Public Health Emergency ,
Telehealth
Report on Medicare Compliance 30, no. 7 (February 22, 2021) -
A Michigan woman is the first in the nation to be charged criminally with misappropriating money from the Provider Relief Fund (PRF), the Department of Justice...more
2/25/2021
/ Ambulatory Surgery Centers ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
Embezzlement ,
Enforcement Actions ,
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Health Care Providers ,
HIPAA Privacy Rule ,
HIPAA Violations ,
Home Health Care ,
Indictments ,
Medicare ,
OCR ,
OIG ,
Provider Relief Fund ,
Right of Access ,
Settlement Agreements
Report on Medicare Compliance 30, no. 4 (February 1, 2021)
- Correction: Medicare’s home oxygen national coverage determination has been waived during the public health emergency. RMC’s Jan. 25 issue stated otherwise. The...more
Report on Medicare Compliance 30, no. 2 (January 18, 2021) -
Recovery audit contractors (RACs) may soon be auditing positron emission tomography (PET) for initial treatment strategy in oncologic conditions for compliance...more
1/22/2021
/ Compliance ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
HIPAA Privacy Rule ,
HIPAA Violations ,
Hospitals ,
Medical Necessity ,
Medical Records ,
Medicare ,
OCR ,
Physicians ,
Recovery Audit Contractors (RACs) ,
Required Documentation ,
Right of Access ,
Settlement Agreements
Report on Medicare Compliance 30, no. 2 (January 18, 2021) -
CMS is taking back money from hospitals for outpatient clinic visits provided in 2019 at excepted off-campus provider-based departments (PBDs) after returning...more
Report on Medicare Compliance 29, no. 45 (December 21, 2020) -
CMS said Dec. 18 it will audit a sample of hospitals for compliance with price transparency requirements, which take effect Jan. 1, according to MLN Connects....more
12/29/2020
/ American Hospital Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Compliance ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Health Care Providers ,
Healthcare Fraud ,
Home Health Care ,
Hospitals ,
Medicare ,
Noncompliance ,
Physical Therapists ,
Price Transparency ,
Section 340B ,
TRICARE
Report on Medicare Compliance 29, no. 45 (December 21, 2020) -
When an orthopedic surgeon demanded very generous compensation, the hospital weighed its clinical and business needs against the compliance risks. It had to...more
Report on Medicare Compliance 29, no. 43 (December 7, 2020) -
In a new provider compliance audit, the HHS Office of Inspector General (OIG) said The Palace at Home, a for-profit home health care agency (HHA) in Miami,...more
12/9/2020
/ Audits ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Home Health Care ,
Medicare ,
New Guidance ,
OIG ,
Overpayment ,
Required Documentation
Report on Medicare Compliance 29, no. 43 (December 7, 2020) -
In the 2021 final Medicare Physician Fee Schedule (MPFS) rule, CMS made both permanent and temporary changes to supervision, telehealth and other provisions,...more
12/8/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Medicare ,
MPFS ,
Physicians ,
Public Health Emergency ,
Supervision ,
Telehealth
Report on Medicare Compliance 29, no. 42 (November 23, 2020)
- CMS said Nov. 16 that the Medicare fee-for-service improper payment rate dropped to 6.27% in FY 2020 from 7.25% last year, although CMS had to “modify”...more
12/1/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fee-for-Service ,
Health Care Providers ,
Healthcare Fraud ,
HIPAA Violations ,
Medical Records ,
Medicare ,
Medicare Advantage ,
OCR ,
OIG ,
Right of Access ,
Settlement
Report on Medicare Compliance 29, no. 39 (November 2, 2020) -
Medtronic USA Inc., a medical device maker, has agreed to pay $8.1 million to settle allegations it violated the False Claims Act by paying kickbacks to induce...more
11/9/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Home Health Agencies ,
Home Health Care ,
Kickbacks ,
Medical Devices ,
Medicare ,
Settlement ,
Telecommunications ,
Telehealth
Report on Medicare Compliance 29, no. 39 (November 2, 2020) -
CMS said Oct. 28 that Medicare will pay hospitals extra when they treat inpatients with drugs or biologicals approved by the Food and Drug Administration (FDA)...more
11/6/2020
/ Add-ons ,
Biologics ,
CARES Act ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Emergency Use Authorization (EUA) ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Hospitals ,
Infectious Diseases ,
Inpatient Prospective Payment System (IPPS) ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Beneficiaries ,
Medicare Part B ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Payment Rates ,
Pharmacies ,
Physicians ,
Prescription Drugs ,
Public Health Emergency ,
Vaccinations ,
Virus Testing
Report on Medicare Compliance 29, no. 35 (October 5, 2020) -
A California physician on Sept. 18 received a letter from a Medicare administrative contractor (MAC) that ordered him to stop sharing pricing information about...more
Report on Medicare Compliance Volume 29, no. 32 (September 14, 2020)
- In an audit of 100 outlier payments, the HHS Office of Inspector General (OIG) said Baylor Scott & White – College Station, a hospital in Texas, didn’t...more
Report on Medicare Compliance 29, no. 30 (August 24, 2020)
- A federal court on Aug. 17 blocked HHS from enforcing its revised definition of sex discrimination in Sec. 1557, which prohibits discrimination on the basis of...more
8/26/2020
/ Amended Rules ,
Appeals ,
Bostock v Clayton County Georgia ,
Compliance ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Gender Identity ,
Health Care Providers ,
Home Health Care ,
Hospice ,
Injunctive Relief ,
Medicare ,
Pregnancy Discrimination ,
SCOTUS ,
Section 1557 ,
Settlement ,
Sex Discrimination ,
Stays
Report on Medicare Compliance 29, no. 30 (August 24, 2020) -
Mission Home Health of San Diego Inc. was overpaid $61,718 in 2015 and 2016, which was extrapolated to $5.9 million, according to the latest Medicare home health...more
Report on Medicare Compliance 29, no. 28 (August 3, 2020) -
The 2017 theft of an unencrypted laptop is at the heart of a new HIPAA settlement with Lifespan Health System Affiliated Covered Entity (Lifespan ACE) in Rhode...more
8/14/2020
/ Business Associates ,
Compliance ,
Electronic Protected Health Information (ePHI) ,
Encryption ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Privacy Rule ,
HIPAA Security Rule ,
Laptop Computers ,
Medicare ,
OCR ,
PHI ,
Settlement ,
Stolen Goods ,
Third-Party Relationships
Report on Medicare Compliance 29, no. 25 (July 13, 2020)
- Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more
7/21/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Durable Medical Equipment ,
False Billing ,
False Claims Act (FCA) ,
Fraud ,
Guidance Update ,
Guilty Pleas ,
Health Care Providers ,
Hospitals ,
Medical Billing Codes ,
Medicare ,
OIG ,
Settlement ,
Telemedicine ,
Work Plans