Report on Medicare Compliance 30, no. 2 (January 18, 2021) -
Recovery audit contractors (RACs) may soon be auditing positron emission tomography (PET) for initial treatment strategy in oncologic conditions for compliance...more
1/22/2021
/ Compliance ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
HIPAA Privacy Rule ,
HIPAA Violations ,
Hospitals ,
Medical Necessity ,
Medical Records ,
Medicare ,
OCR ,
Physicians ,
Recovery Audit Contractors (RACs) ,
Required Documentation ,
Right of Access ,
Settlement Agreements
Report on Medicare Compliance 30, no. 2 (January 18, 2021) -
CMS is taking back money from hospitals for outpatient clinic visits provided in 2019 at excepted off-campus provider-based departments (PBDs) after returning...more
Report on Medicare Compliance 29, no. 45 (December 21, 2020) -
CMS said Dec. 18 it will audit a sample of hospitals for compliance with price transparency requirements, which take effect Jan. 1, according to MLN Connects....more
12/29/2020
/ American Hospital Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Compliance ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Health Care Providers ,
Healthcare Fraud ,
Home Health Care ,
Hospitals ,
Medicare ,
Noncompliance ,
Physical Therapists ,
Price Transparency ,
Section 340B ,
TRICARE
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. 43 (December 7, 2020) -
In the 2021 final Medicare Physician Fee Schedule (MPFS) rule, CMS made both permanent and temporary changes to supervision, telehealth and other provisions,...more
12/8/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Medicare ,
MPFS ,
Physicians ,
Public Health Emergency ,
Supervision ,
Telehealth
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 29, no. 39 (November 2, 2020) -
Medtronic USA Inc., a medical device maker, has agreed to pay $8.1 million to settle allegations it violated the False Claims Act by paying kickbacks to induce...more
11/9/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Home Health Agencies ,
Home Health Care ,
Kickbacks ,
Medical Devices ,
Medicare ,
Settlement ,
Telecommunications ,
Telehealth
Report on Medicare Compliance 29, no. 39 (November 2, 2020) -
CMS said Oct. 28 that Medicare will pay hospitals extra when they treat inpatients with drugs or biologicals approved by the Food and Drug Administration (FDA)...more
11/6/2020
/ Add-ons ,
Biologics ,
CARES Act ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Emergency Use Authorization (EUA) ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Hospitals ,
Infectious Diseases ,
Inpatient Prospective Payment System (IPPS) ,
Interim Final Rules (IFR) ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Beneficiaries ,
Medicare Part B ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Payment Rates ,
Pharmacies ,
Physicians ,
Prescription Drugs ,
Public Health Emergency ,
Vaccinations ,
Virus Testing
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. 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