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. 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. 2 (January 20, 2020) -
CMS has agreed to pay a physical therapy practice $55,000 in a December settlement that’s at the intersection of claims and enrollment, and again runs into the...more
1/24/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Enrollment ,
MACs ,
Medicare ,
Medicare Billing Privileges ,
Medicare Program Integrity Manual (MPIM) ,
PECOS ,
Physical Therapists ,
Provider Payments ,
Remedies ,
Retroactive Application ,
Settlement ,
Transitional Arrangements
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
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 28, no. 44 (December 16, 2019) -
One way to find out whether compliance and integrity have seeped into the bones of an organization is asking people who would know. There may be a compliance...more
12/16/2019
/ Attorney General ,
Audits ,
C-Suite Executives ,
Compliance ,
Compliance Monitoring ,
Corporate Integrity Agreement ,
Corporate Monitoring ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Executive Compensation ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Incentives ,
Medicare ,
OIG ,
Physicians ,
Stark Law
Report on Medicare Compliance 28, no. 42 (November 25, 2019)
- In a surprising CMS memo that just surfaced, top CMS attorneys echo the sentiments of the Department of Justice about the limits of enforcement actions based...more
11/26/2019
/ Azar v Allina Health Services ,
Comment Period ,
Compliance ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
Enforcement Actions ,
Fee-for-Service ,
Guidance Documents ,
Home Health Care ,
Medicare ,
Medicare Part B ,
Notice and Comment ,
Payment Rates
Report on Medicare Compliance 28, no. 41 (November 18, 2019) -
- North Carolina physician Damian Brezinski and his medical group, Wilmington Health, agreed to pay $244,000 to settle false claims allegations in connection...more
11/18/2019
/ Compliance ,
Conflicts of Interest ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Clinics ,
Medical Devices ,
Medicare ,
Physician-Owned Distributors ,
Settlement ,
TRICARE ,
Unnecessary Medical Procedures
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