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
Report on Medicare Compliance Volume 32, no 25 (July 2023)
The former chief hospital executive of Bayonne Medical Center (BMC) in New Jersey has filed a False Claims Act (FCA) lawsuit alleging the hospital and two others...more
7/18/2023
/ CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
HRSA ,
Overpayment ,
Provider Relief Fund ,
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 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. 11 (March 22, 2021) -
A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the...more
3/23/2021
/ Administrative Law Judge (ALJ) ,
Appeals ,
Billing Errors ,
Civil Monetary Penalty ,
False Claims Act (FCA) ,
Health Care Providers ,
Medicare ,
Medicare Part B ,
Medicare Prescription Drug Improvement and Modernization Act (MMA) ,
Overpayment ,
Physicians ,
Settlement
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) -
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. 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
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. 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 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