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.^[1] In addition, CMS will investigate complaints submitted to CMS and review “analyses of non-compliance, and hospitals may face civil monetary penalties for noncompliance.” CMS has a website for people to report noncompliance.^[2]

◆ The American Hospital Association (AHA), Association of American Medical Colleges and other groups said Dec. 14 they have filed a lawsuit^[3] against HHS, alleging it failed to enforce the requirements of the 340B drug discount program. “This lawsuit will require the department to take actions that we’ve long called for against drug companies that are disregarding the law by limiting the distribution of certain 340B drugs to eligible hospitals. It’s time to stop these illegal actions from drug companies and protect vulnerable patients and communities,” said AHA President and CEO Rick Pollack.^[4]

◆ Total Patient Care Home Health LLC (TPC) in Richardson, Texas, was overpaid $75,461, according to a new provider compliance audit of 100 claims submitted between October 2014 and Sept. 30, 2016.^[5] There were errors on 32 of 100 home health claims reviewed, the HHS Office of Inspector General (OIG) contends. Either patients weren’t homebound or didn’t require skilled services. “On the basis of our sample results, we estimated that TPC received overpayments of at least $1.7 million for our audit period,” OIG said. TPC disputed the findings and said it will appeal.

◆ A physical therapy provider in Georgia agreed to pay $506,811 to settle false claims allegations, the U.S. Attorney’s Office for the Middle District of Georgia said Dec. 15.^[6] McLeod-Hughes & Associates LLC and its owner, Barry McLeod-Hughes, allegedly submitted bills to Medicare and TRICARE for physical therapy services provided by unlicensed, uncredentialed or otherwise unapproved individuals. McLeod-Hughes voluntarily agreed to be excluded from Medicare and other federal health care programs.

1 CMS, “Monitoring for Hospital Price Transparency,” MLN Connects, December 18, 2020, http://go.cms.gov/3aBhFdx.
2 “Contact Us,” CMS, last modified September 30, 2020, http://go.cms.gov/38kBi6u.
3 The American Hospital Association et al v. The Department of Health and Human Services, Case No. 3:20-cv-08806 (N.D. Cal., December 11, 2020), https://bit.ly/3mD5yis.
4 American Hospital Association, “Hospitals and Pharmacists File Lawsuit over Drug Companies’ Refusals of 340B Discounts,” news release, December 11, 2020, http://bit.ly/2LGCfys.
5 Amy J. Frontz, “Medicare Home Health Agency Provider Compliance Audit: Total Patient Care Home Health, LLC,” HHS, December 2020, https://go.usa.gov/xArMa.
6 Department of Justice, U.S. Attorney’s Office for the Middle District of Georgia, “Middle Georgia PT Provider Agrees To Pay $500k+ To Resolve Fraud Claims,” news release, December 15, 2020, http://bit.ly/34seJMl.

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