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) -
Medicare administrative contractors (MACs) will be coming to 911 hospitals for overpayments caused by unreported manufacturer credits for recalled or...more
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 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 Volume 29, no. 32 (September 14, 2020) -
Wheeling Hospital in West Virginia has agreed to pay $50 million to settle a False Claims Act (FCA) lawsuit over physician compensation, the Department...more
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
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 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. 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 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) -
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. 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. 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 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. 39 (November 4, 2019) -
? The former CEO of Putnam County Memorial Hospital in Unionville, Missouri, pleaded guilty to one count of conspiracy to commit health care fraud, the Department...more
11/13/2019
/ Blood Tests ,
CEOs ,
Compliance ,
Criminal Convictions ,
Department of Justice (DOJ) ,
Fraud and Abuse ,
Guilty Pleas ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
Medicare Beneficiaries ,
Patient Safety ,
Physicians
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