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In Biggest Stark-Based FCA Settlement Ever, Indiana Hospital Pays $345M, Has Unusual CIA

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

Hospital Settles CMP Case Over Free APPs; 'Bona Fide' Use Shouldn't Inspire Fear, Lawyer Says

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

News Briefs: September 11, 2023

The HHS Office for Civil Rights (OCR) on Sept. 7 announced a proposed rule to bar discrimination based on disability.[1] “The rule, Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal...more

OIG: COVID-19 UIP Overpaid Providers $784M; HRSA Will Recoup Money

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

Report on Medicare Compliance Volume 31, Number 43. News Briefs: December 2022

HealthOne Critical Care Transport Service Inc., doing business as MedicOne Medical Response of Marion, Illinois, has agreed to pay $302,124 to settle allegations it improperly billed Medicare for scheduled, non-emergency...more

Report on Medicare Compliance Volume 31, Number 35. News Briefs: September 2022

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

New Hampshire Health System Pays $2.1M in CMP Settlement Over Diagnostic Test Orders

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

Sanford Settles Telehealth Case Over One Physician; It Disclosed Reportable Event

Report on Medicare Compliance 31 no. 29 (August 15, 2022) - Sanford Health, Sanford Clinic and Sanford Medical Center in South Dakota have agreed to pay $25,842 in a settlement about telemedicine services with the HHS...more

Report on Medicare Compliance Volume 31, Number 18. News Briefs: May 2022

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

Report on Medicare Compliance Volume 31, Number 14. News Briefs: April 2022

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

Academic Medical Center Settles Case Over Excluded Person Who Was Both Employee, Vendor

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

Hospital Settles FCA Case Filed by CO Over Modifiers; Make Sure People ‘Feel Heard’

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

Credible Information Is Heart of 60-Day Rule; OIG: Self-Disclosure Pauses the Clock

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

Radiation Therapy Provider Pays $3.6M in CMP Settlement; OIG: 25 CPT Codes ‘Involved’

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

Report on Medicare Compliance Volume 30, Number 17. News Briefs: May 2021

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

Report on Medicare Compliance Volume 30, Number 15. News Briefs: April 2021 #3

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

Report on Medicare Compliance Volume 30, Number 11. News Briefs: March 2021 #2

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

Hospital, Doctors Pay $3M to Settle CMPL Case Over Cath Lab Lease

Report on Medicare Compliance 30, no. 4 (February 1, 2021) - Saint Peter’s University Hospital and New Brunswick Cardiac Cath Lab LLC in New Jersey have agreed to pay $3.04 million to settle a civil monetary penalty case...more

Report on Medicare Compliance Volume 29, Number 43. News Briefs: December 2020

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

Report on Medicare Compliance Volume 29, Number 42. News Briefs: November 2020 #2

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

Hospitals Were Overpaid $33M Over Device Credits; Policy May Change

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 Volume 29, Number 32. News Briefs: September 2020

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

In Provider Compliance Audit, OIG Said HHA Was Overpaid $5.9M

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

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