Posts Tagged ‘HHS’
How data mining is uncovering healthcare fraud
What does your data say about your healthcare practice? Does it show that you bill considerably more than your colleagues for certain types of procedures? What about your facility? Is it performing more of a particular procedure than nearby competitors? These days, healthcare fraud investigators increasingly rely on data to root out healthcare fraud. They…
Read MoreFeds to increase exclusion and civil monetary penalty enforcement cases
When it comes to exclusion and civil monetary penalty cases, the federal government is preparing to take an even harder line than in the past. During the recent Health Care Compliance Association’s Healthcare Enforcement Compliance Institute, Gregory Demske, chief counsel at the Health and Human Services Office of Inspector General, told an audience his agency…
Read MoreOIG opinion: Free transportation doesn’t violate anti-kickback statute
The U.S. Department of Health and Human Services Office of Inspector General recently issued an opinion stating that a large healthcare system’s free van shuttle service for patients does not violate the federal anti-kickback statute. The statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce…
Read MoreOMHA to expand Medicare appeals process
Faced with skyrocketing processing times, the Office of Medicare Hearings and Appeals (OMHA) says it plans to expand its Settlement Conference Facilitation pilot project in an effort to clear through the ever-growing backlog of claims appeals. The pilot project, which began in June 2014, is an alternative dispute resolution process. It was created to bring…
Read MoreOIG opinion: Free home health visits are not kickbacks
The U.S. Department of Health and Human Services Office of Inspector General recently issued an opinion that a home healthcare provider’s policy to offer free introductory visits to patients who have already chosen it as their provider does not violate the federal anti-kickback statute. In its request for an advisory opinion, the home healthcare provider…
Read MoreCMS to cut providers a break when it comes to ICD-10 deadline
With the implementation of ICD-10 just around the corner (Oct. 1) comes word from the Centers for Medicare & Medicaid Services that it will not deny claims made under the Part B physician fee schedule if there are coding errors. The guidance notice, which was issued with the blessing of the American Medical Association, is…
Read MoreFederal prosecutors increasingly target individual healthcare execs in anti-fraud efforts
Last month’s sentencing of the former president and CEO of OtisMed Corporation to two years in prison should serve as yet another example that federal prosecutors are not holding back when it comes to holding corporate executives accountable. Charlie Chi was sentenced for intentionally distributing a medical device used in knee replacement surgery despite the…
Read MoreOIG adds 21 new investigative focus areas
The Office of Inspector General at the U.S. Department of Health and Human Services recently released the midyear update of its annual work plan, which not only outlined its accomplishments between October 2014 and May 2015 but also added 21 new focus areas for next year. The OIG noted that it will continue to look…
Read MoreOIG cracks down on place-of-service overpayments
Is your practice using proper place-of-service codes? If not, you’re not alone. According to a new report from the HHS Office of Inspector General, Medicare contractors may have overpaid physicians to the tune of $33.4 million for incorrectly coded services provided between January 2010 and September 2012. Why? It appears that the services were performed…
Read MoreHHS: Medicare payments to be tied to quality, not quantity
The U.S. Department of Health and Human Services announced this week that future Medicare payments will be linked to quality and not quantity. This is the first time the federal agency has set specific goals designed to move away from plans that reward providers for the amount of care they provide instead of the quality…
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