Hospitals and other providers should brace for recoupment of possibly hundreds of millions of dollars they were reportedly overpaid for services provided under the COVID-19 uninsured program (UIP) in the wake of new audit...more
8/17/2023
/ Audits ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
HRSA ,
OIG ,
Overpayment ,
Provider Relief Fund ,
Relief Measures ,
Whistleblower Awards ,
Whistleblowers
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 31, no. 9 (March 14, 2022) -
Congress has given telehealth services a new lease on life, at least for five months beyond the end of the COVID-19 public health emergency (PHE), in the $1.5...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. 17 (May 3, 2021) -
With the pandemic in its second year, coding and documentation of long-haul COVID-19 patients who are admitted or readmitted to the hospital may be a sleeper risk....more
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) -
When employees are required to show their employers proof of a positive COVID-19 test before they get sick leave or a vaccination before returning to work, the...more
4/14/2021
/ Coronavirus/COVID-19 ,
Data Privacy ,
Data Protection ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Records ,
Mobile Apps ,
Privacy Laws
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 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. 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. 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. 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 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. 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. 18 (May 11, 2020)
- The HHS Office for Civil Rights has posted guidance reminding providers that “the COVID-19 public health emergency does not alter the HIPAA Privacy Rule’s existing...more
5/16/2020
/ Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Electronic Protected Health Information (ePHI) ,
False Accusations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hiring & Firing ,
Medicare ,
Nurses ,
OCR ,
Patient Privacy Rights ,
PHI ,
Professional Associations ,
Public Health Emergency ,
Retaliation ,
Unions ,
Workplace Safety
Report on Medicare Compliance 29, no. 18 (May 11, 2020) -
The gyms and dorm rooms at Sonoma State University in California are an alternate care site for St. Joseph Health System in Santa Rosa and other health care...more
Report on Medicare Compliance 29, no. 16 (April 27, 2020) -
Because of the coronavirus, the talents of a business development executive at a hospital are wasted, and the chief financial officer (CFO) is wondering whether...more
5/2/2020
/ CARES Act ,
CFOs ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Federal Grants ,
Health Care Providers ,
Healthcare Facilities ,
Hospitals ,
Medicare ,
Provider Relief Fund ,
Public Health Emergency ,
Relief Measures ,
Risk Assessment ,
Risk Mitigation ,
Terms and Conditions
Report on Medicare Compliance 29, no. 13 (April 6, 2020)
- During the coronavirus pandemic, the HHS Office of Inspector General (OIG) is “trying to minimize the burdens on providers,” said Christi Grimm, principal deputy...more
4/20/2020
/ Compliance ,
Coronavirus/COVID-19 ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
HIPAA Privacy Rule ,
Hospitals ,
Medicare ,
OCR ,
OIG ,
Overpayment Recovery Time Limits ,
Unduly Burdensome
Report on Medicare Compliance 29, no. 12 (March 30, 2020)
In a March 26 email, CMS said hospitals have flexibility to deliver Medicare notices to patients with suspected or confirmed cases of COVID-19. “Hard copies of...more
Report on Medicare Compliance 29, no. 10 (March 16, 2020) -
? Millennium Physicians Association PLLC, which owns two sleep centers in the Houston area, has paid $1,248,964 to settle false claims allegations over sleep...more