Report on Medicare Compliance 29, no. 24 (June 29, 2020) -
CMS said June 23 it has created an Office of Burden Reduction and Health Informatics to “unify the agency’s efforts to reduce regulatory and administrative burden...more
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. 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. 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. 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. 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) -
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. 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. 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 28, no. 44 (December 16, 2019) -
? Korunda Medical LLC, a Florida-based company that provides primary care and interventional pain management, has agreed to pay $85,000 to settle a potential...more
12/17/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Care Violations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Necessity ,
Medicare ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Overpayment ,
Provider Payments ,
Right of Access ,
Settlement
Report on Medicare Compliance Volume 28, Number 40. (November 11, 2019) -
- In a new Medicare compliance review, the HHS Office of Inspector General (OIG) said Angels Care Home Health in Salina, Kansas, didn’t comply with...more
11/15/2019
/ Change of Ownership ,
Compliance ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Home Health Care ,
Inpatient Prospective Payment System (IPPS) ,
Medical Insurance Codes ,
Medicare ,
NIST ,
OCR ,
OIG ,
ONC ,
Security Risk Assessments
Report on Medicare Compliance 28, no. 40 (November 11, 2019) -
CMS has given the green light to prior authorization for five types of procedures in an attempt to control “unnecessary increases” in these procedures as part...more
11/14/2019
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Health Care Providers ,
Hospitals ,
Inpatient Billing ,
Medical Insurance Codes ,
Medicare ,
Medicare Appeals ,
MPFS ,
OMB ,
Opioid ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Physician Assistants ,
Physician Fee Schedule ,
Physicians ,
Prior Authorization ,
Transparency
Report on Medicare Compliance 28, no. 38 (Oct. 28, 2019) -
- Doctors Hospital of Augusta in Georgia agreed to pay $180,000 in a civil monetary penalty settlement over alleged violations of the Emergency Medical Treatment...more
10/28/2019
/ Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
EMTALA ,
Enforcement Actions ,
Federal Health Care Programs (FHCP) ,
Fraud Risk Indicator ,
Health Care Providers ,
Hospitals ,
Integrity Policies ,
Medicare ,
OIG ,
Physicians ,
Request For Information ,
Statutory Violations ,
Value-Based Care ,
Work Plans
- Fresenius Medical Care North America Inc. has agreed to pay $5.2 million to settle allegations that it tested dialysis patients for Hepatitis B surface antigen more often than medically necessary and billed Medicare for the...more
10/15/2019
/ Civil Monetary Penalty ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Federal Contractors ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Breach ,
HIPAA Privacy Rule ,
Medical Necessity ,
Medicare ,
OCR ,
Settlement Agreements
Starting Oct. 1, per diem payments to skilled nursing facilities (SNFs) will be more generous on the first few days of a Medicare beneficiary’s stay, and then drop as the stay continues. That’s one of the changes under the...more