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
2/20/2024
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
Compensation ,
Competition ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Employment Contract ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
OIG ,
Physicians ,
Stark Law ,
Whistleblowers
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
1/31/2024
/ Anti-Kickback Statute ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Litigation Strategies ,
OIG ,
Popular ,
Self-Disclosure Requirements ,
Settlement ,
Stark Law
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
1/31/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Disability ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Non-Discrimination Rules ,
OCR ,
OIG ,
Patients ,
Proposed Rules ,
Regulatory Agenda ,
Rehabilitation Act
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
8/17/2023
/ Audits ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
HRSA ,
OIG ,
Overpayment ,
Provider Relief Fund ,
Relief Measures ,
Whistleblower Awards ,
Whistleblowers
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
12/6/2022
/ Ambulance Providers ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Billing ,
Healthcare ,
Medical Billing Codes ,
Medicare ,
Non-Emergency Medical Transportation (NEMT) ,
OIG ,
Overpayment ,
Settlement
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
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
9/29/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Diagnostic Tests ,
False Billing ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
OIG ,
Overpayment ,
Physicians ,
Settlement ,
TRICARE
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 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
5/18/2022
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Home Health Care ,
Hospitals ,
Medicare ,
Medicare Beneficiaries ,
OIG ,
Patient Safety ,
Settlement
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
4/20/2022
/ Audits ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medicaid ,
OIG ,
Physicians ,
Settlement Agreements ,
Unnecessary Medical Procedures ,
Work Plans
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
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
9/16/2021
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Overpayment ,
Personal Liability ,
Physicians ,
Settlement Agreements ,
Whistleblowers
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
8/4/2021
/ 60-Day Rule ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Overpayment ,
Physicians ,
Provider Self-Disclosure Protocol
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
6/16/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
False Billing ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medical Billing Codes ,
Medicare ,
OIG ,
Overpayment ,
Physicians ,
Settlement Agreements
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
5/6/2021
/ Audits ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Health Care Providers ,
Medicaid ,
Medicare ,
OIG ,
Overpayment
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. 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. 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 ,
Department of Health and Human Services (HHS) ,
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. 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 ,
Enforcement Authority ,
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) -
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
2/3/2021
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Hospitals ,
Investors ,
OIG ,
Pay-Per-Click ,
Physicians ,
Provider Self-Disclosure Protocol ,
Remuneration ,
Settlement Agreements ,
Stark Law
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. 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. 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, 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) -
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