The HHS Office for Civil Rights (OCR) on Sept. 7 announced a proposed rule to bar discrimination based on disability.[1] “The rule, Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal...more
1/31/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Disability ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Non-Discrimination Rules ,
OCR ,
OIG ,
Patients ,
Proposed Rules ,
Regulatory Agenda ,
Rehabilitation Act
Report on Medicare Compliance Volume 32, no 29 (August 2023)
In a new Medicare transmittal (12,202), CMS introduced a new place of service (POS) code (27) for “Outreach Site/Street.” POS 27 is defined as “a non-permanent...more
Report on Medicare Compliance Volume 32, no 25 (July 2023)
The former chief hospital executive of Bayonne Medical Center (BMC) in New Jersey has filed a False Claims Act (FCA) lawsuit alleging the hospital and two others...more
7/18/2023
/ CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
HRSA ,
Overpayment ,
Provider Relief Fund ,
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
In what passes for neon lights in the regulatory world, CMS said Medicare Advantage (MA) plans must follow the two-midnight rule, its case-by-case exception and the inpatient-only (IPO) list, according to the final 2024 rule...more
4/10/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Hospitals ,
Local Coverage Determination (LCD) ,
MACs ,
Medicare ,
Medicare Advantage ,
Two-Midnight Rule
Report on Medicare Compliance 31, no. 35 (September 26, 2022)
- The HHS Office of Inspector General (OIG) on Sept. 23 unveiled a new template for requesting advisory opinions.
- In a new report, OIG said CMS edits...more
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. 18 (May 16, 2022)
- In a new report, the HHS Office of Inspector General (OIG) said 25% of Medicare beneficiaries experienced patient harm (adverse events and temporary harm events)...more
5/18/2022
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Home Health Care ,
Hospitals ,
Medicare ,
Medicare Beneficiaries ,
OIG ,
Patient Safety ,
Settlement
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) -
CMS has not fined any hospitals yet for noncompliance with price transparency requirements, a spokesperson tells RMC. “In April 2021, CMS began issuing warning...more
8/5/2021
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Corrective Action Plans (CAPs) ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Noncompliance ,
Outpatient Prospective Payment System (OPPS) ,
Price Transparency ,
Warning Letters
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. 17 (May 3, 2021) -
In a new provider compliance audit, the HHS Office of Inspector General (OIG) said Visiting Nurse Association of Maryland (VNA) received overpayments of $2.1...more
5/6/2021
/ Audits ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Health Care Providers ,
Medicaid ,
Medicare ,
OIG ,
Overpayment
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. 14 (April 12, 2021) -
Doctors Care P.A., the largest urgent care provider network in South Carolina, and its management company, UCI Medical Affiliates of South Carolina Inc., will...more
4/15/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Medicaid ,
Medicare ,
Proposed Regulation ,
TRICARE ,
Urgent Care Facilities ,
Whistleblowers
Report on Medicare Compliance 30, no. 13 (April 5, 2021) -
Because of the COVID-19 pandemic, CMS said April 1 that it won’t update the 855 enrollment form with sections on “affiliation disclosures,” as planned in a 2019...more
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. 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. 7 (February 22, 2021) -
A Michigan woman is the first in the nation to be charged criminally with misappropriating money from the Provider Relief Fund (PRF), the Department of Justice...more
2/25/2021
/ Ambulatory Surgery Centers ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
Embezzlement ,
Enforcement Actions ,
Enforcement Authority ,
Health Care Providers ,
HIPAA Privacy Rule ,
HIPAA Violations ,
Home Health Care ,
Indictments ,
Medicare ,
OCR ,
OIG ,
Provider Relief Fund ,
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