Report on Medicare Compliance 29, no. 35 (October 5, 2020)
- In a major national enforcement action, the Department of Justice (DOJ) and other federal agencies said Sept. 30 they have charged 345 people, including more...more
10/15/2020
/ Compliance ,
Criminal Prosecution ,
Electronic Protected Health Information (ePHI) ,
Employee Misconduct ,
Enforcement Actions ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Fraud ,
Hackers ,
Healthcare Workers ,
Medicare ,
Physicians ,
Sentencing ,
Telemedicine
Report on Medicare Compliance 29, no. 35 (October 5, 2020) -
A California physician on Sept. 18 received a letter from a Medicare administrative contractor (MAC) that ordered him to stop sharing pricing information about...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 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. 30 (August 24, 2020)
- A federal court on Aug. 17 blocked HHS from enforcing its revised definition of sex discrimination in Sec. 1557, which prohibits discrimination on the basis of...more
8/26/2020
/ Amended Rules ,
Appeals ,
Bostock v Clayton County Georgia ,
Compliance ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Gender Identity ,
Health Care Providers ,
Home Health Care ,
Hospice ,
Injunctive Relief ,
Medicare ,
Pregnancy Discrimination ,
SCOTUS ,
Section 1557 ,
Settlement ,
Sex Discrimination ,
Stays
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. 28 (August 3, 2020)
- The HHS Office of Inspector General (OIG) has given the green light to a plan by a charitable organization to “purchase or receive donations of unpaid medical...more
8/17/2020
/ Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Charitable Donations ,
Charitable Organizations ,
Compliance ,
Coronavirus/COVID-19 ,
Debt Forgiveness ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Medical Coding ,
Medical Debt ,
Medicare ,
OIG ,
Physician Payments ,
Public Health Emergency ,
Relief Measures
Report on Medicare Compliance 29, no. 28 (August 3, 2020) -
The 2017 theft of an unencrypted laptop is at the heart of a new HIPAA settlement with Lifespan Health System Affiliated Covered Entity (Lifespan ACE) in Rhode...more
8/14/2020
/ Business Associates ,
Compliance ,
Electronic Protected Health Information (ePHI) ,
Encryption ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Privacy Rule ,
HIPAA Security Rule ,
Laptop Computers ,
Medicare ,
OCR ,
PHI ,
Settlement ,
Stolen Goods ,
Third-Party Relationships
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. 25 (July 13, 2020) -
When a physician’s telehealth visit with a Medicare patient on FaceTime cut out after five minutes, they shifted to an audio-only visit, with the physician and...more
7/20/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Controlled Substances Act ,
Electronic Prescribing ,
Home Health Care ,
Medicare ,
OIG ,
Physician Fee Schedule ,
Provider Payments ,
Public Health Emergency ,
Telehealth ,
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 29, no. 23 (June 22, 2020):
- CMS has created a new point of origin (PoO) code, G, to indicate a transfer from a designated disaster alternative care site (ACS) because of changes in connection...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. 21 (June 8, 2020) -
The HHS Office of Inspector General (OIG) has released its Semiannual Report to Congress, which covers Oct. 1, 2019, through March 31, 2020. During this period, OIG...more
Report on Medicare Compliance 29, no. 21 (June 8, 2020) -
Whether an organization shows its commitment to compliance with dollars is a new focus of the second update to guidance on evaluating compliance programs from the...more
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 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