H. Lee Moffitt Cancer Center & Research Institute Hospital Inc. in Tampa, Florida, has agreed to pay $19.564 million to settle false claims allegations over claims submitted to federal health care programs for items and...more
2/20/2024
/ Clinical Trials ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
HIPAA Privacy Rule ,
Medical Records ,
Medicare ,
OCR ,
Provider Self-Disclosure Protocol ,
Settlement
In a case that may hit a raw compliance nerve, Ascension Macomb Oakland Hospital in Michigan has agreed to pay $100,000 in a settlement with the HHS Office of Inspector General (OIG) over free services provided to certain...more
1/31/2024
/ Anti-Kickback Statute ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Litigation Strategies ,
OIG ,
Popular ,
Self-Disclosure Requirements ,
Settlement ,
Stark Law
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)
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
HealthOne Critical Care Transport Service Inc., doing business as MedicOne Medical Response of Marion, Illinois, has agreed to pay $302,124 to settle allegations it improperly billed Medicare for scheduled, non-emergency...more
12/6/2022
/ Ambulance Providers ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Billing ,
Healthcare ,
Medical Billing Codes ,
Medicare ,
Non-Emergency Medical Transportation (NEMT) ,
OIG ,
Overpayment ,
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. 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 31, no. 2 (January 17, 2022) -
Thomas Jefferson University Hospitals Inc., an academic medical center in Philadelphia, Pennsylvania, has entered into a settlement with the HHS Office of...more
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 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. 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. 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. 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. 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. 7 (February 24, 2020)
- Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more
2/28/2020
/ Acute Facilities ,
CCJR ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Elder Care ,
False Claims Act (FCA) ,
Health Care Providers ,
MACs ,
Medicare ,
OIG ,
Provider Payments ,
Recoupment ,
Settlement ,
Skilled Nursing Facility ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 29, no. 6 (February 17, 2020) -
Tenet Healthcare Corp. and an affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.41 million to settle False Claims Act (FCA)...more
2/19/2020
/ Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Hospitals ,
Kickbacks ,
Medicaid ,
Medical Equipment ,
Medicare ,
Physicians ,
Settlement ,
TRICARE ,
Unnecessary Medical Procedures ,
Whistleblowers
Report on Medicare Compliance 29, no. 4 (February 3, 2020) -
? Central Coast Inpatient Consultants Inc. in California has agreed to pay $750,000 in a civil monetary penalty settlement with the HHS Office of Inspector...more
2/6/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Compliance ,
Enforcement Actions ,
False Claims Act (FCA) ,
HCPCS ,
Health Care Providers ,
Medicare ,
Medicare Billing Privileges ,
Medicare Fraud ,
Medicare Provider Agreements ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Restitution ,
Settlement
Report on Medicare Compliance 29, no. 2 (January 20, 2020) -
- The HHS Office of Inspector General has updated its Work Plan, which includes an item on early discharges from inpatient rehabilitation facilities to home...more
1/27/2020
/ Civil Monetary Penalty ,
Compliance ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Medicare Fraud ,
OIG ,
Psychiatrists ,
Settlement ,
TRICARE ,
Whistleblowers
Report on Medicare Compliance 29, no. 2 (January 20, 2020) -
CMS has agreed to pay a physical therapy practice $55,000 in a December settlement that’s at the intersection of claims and enrollment, and again runs into the...more
1/24/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Enrollment ,
MACs ,
Medicare ,
Medicare Billing Privileges ,
Medicare Program Integrity Manual (MPIM) ,
PECOS ,
Physical Therapists ,
Provider Payments ,
Remedies ,
Retroactive Application ,
Settlement ,
Transitional Arrangements
Report on Medicare Compliance 28, no. 44 (December 16, 2019) -
? Korunda Medical LLC, a Florida-based company that provides primary care and interventional pain management, has agreed to pay $85,000 to settle a potential...more
12/17/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Care Violations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Necessity ,
Medicare ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Overpayment ,
Provider Payments ,
Right of Access ,
Settlement
Report on Medicare Compliance 28, no. 41 (November 18, 2019) -
- North Carolina physician Damian Brezinski and his medical group, Wilmington Health, agreed to pay $244,000 to settle false claims allegations in connection...more
11/18/2019
/ Compliance ,
Conflicts of Interest ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Clinics ,
Medical Devices ,
Medicare ,
Physician-Owned Distributors ,
Settlement ,
TRICARE ,
Unnecessary Medical Procedures