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 violation of HIPAA’s right of access provision, the HHS Office for Civil Rights (OCR) said Dec. 12. This is OCR’s second settlement[1] since it announced its HIPAA Right of Access Initiative.[2] OCR said it got a complaint in March 2019 that Korunda did not forward a patient’s medical records in an electronic format to a third party in a timely manner in the format requested, and charged more than the reasonable cost-based fees permitted by HIPAA. After providing technical assistance to Korunda, OCR closed the complaint. But history repeated itself, and another complaint was filed. “As a result of OCR’s second intervention, the requested records were provided for free in May 2019, and in the format requested,” OCR said. Korunda did not admit liability.
◆ St. Vincent Hospital, a 720-bed acute-care hospital in Indianapolis, Indiana, was overpaid $293,404 for mistakes on 58 claims, according to a new Medicare compliance review[3] by the HHS Office of Inspector General (OIG), which now refers to this type of review as a “provider compliance audit.” OIG audited a stratified random sample of 145 claims paid in 2016 and 2017. “On the basis of our sample results, we estimated that the Hospital received overpayments of at least $2.1 million for the audit period.” OIG contended that inpatient rehabilitation services were not medically necessary for that level of care and, inpatient admissions should have been outpatient or observation, among other errors, OIG contended. In a written response to OIG, the hospital agreed with some of the findings and has taken corrective action. St. Vincent disagrees with other findings, however. For example, on the inpatient rehabilitation facility claims, “St. Vincent’s review of the claims indicate medical necessity criteria were met in all cases” and will pursue appeals.
◆ CMS said Dec. 12 it will repay hospitals for payment reductions under Medicare's site-neutral payment policy under the Outpatient Prospective Payment System. “Starting January 1, 2020, and over the next few months, the Medicare Administrative Contractors will automatically reprocess claims paid at the reduced rate; no provider action needed,” CMS said.[4]
◆ Correction: Any exceptions to compliance with corporate integrity agreements or federal health care program requirements “would need to be clearly defined” for the HHS Office of Inspector General “in order for a management certification to be acceptable,” OIG Senior Counsel Felicia Heimer says. An article in the Dec. 9 print version of RMC states that OIG doesn’t necessarily consider it a red flag if managers at organizations under a CIA submit compliance certifications with a proviso that essentially says “more or less,” but Heimer says that’s not true.
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