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
Report on Medicare Compliance Volume 32, no 25 (July 2023)
Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional...more
7/18/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
False Billing ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Hospice ,
Medicaid ,
Medicare ,
Physicians ,
Settlement
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. 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. 14 (April 18, 2022) -
The Department of Justice (DOJ) said April 11 it has intervened in a whistleblower lawsuit against Methodist Le Bonheur Healthcare (MLH) in Memphis, Tennessee,...more
Report on Medicare Compliance 30, no. 32 (September 13, 2021) -
Saint Francis Medical Center in Missouri agreed to pay $1.625 million in a civil settlement of allegations it violated the Controlled Substances Act, the...more
9/17/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Controlled Substances ,
Controlled Substances Act ,
Coronavirus/COVID-19 ,
Employer Mandates ,
FBI ,
Government Investigations ,
Health Care Providers ,
Healthcare Workers ,
Hospitals ,
Medicaid ,
Medicare ,
Opioid ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Phishing Scams ,
Physicians ,
Prescription Drugs ,
Ransomware ,
Vaccinations
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) -
CMS’ supplemental medical review contractor (SMRC) is now doing postpayment reviews of Medicare claims for electrodiagnostic (EDX) testing axial muscles and...more
6/17/2021
/ Anti-Kickback Statute ,
Bribery ,
Centers for Medicare & Medicaid Services (CMS) ,
Criminal Conspiracy ,
Guilty Pleas ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
SMRC
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. 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. 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 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. 8 (March 1, 2021) -
After the 2021 Medicare Physician Fee Schedule extended coverage of many telehealth services until the end of the public health emergency (PHE), including...more
3/2/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Denial of Insurance Coverage ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Medicare ,
Physician Fee Schedule ,
Physician Medicare Reimbursements ,
Physicians ,
Public Health Emergency ,
Telehealth
Report on Medicare Compliance 30, no. 4 (February 1, 2021)
- Correction: Medicare’s home oxygen national coverage determination has been waived during the public health emergency. RMC’s Jan. 25 issue stated otherwise. The...more
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 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 29, no. 45 (December 21, 2020) -
When an orthopedic surgeon demanded very generous compensation, the hospital weighed its clinical and business needs against the compliance risks. It had to...more
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. 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. 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. 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