Report on Medicare Compliance Volume 30, Number 2. News Briefs - January 2021

Health Care Compliance Association (HCCA)
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Health Care Compliance Association (HCCA)

Report on Medicare Compliance 30, no. 2 (January 18, 2021)

Recovery audit contractors (RACs) may soon be auditing positron emission tomography (PET) for initial treatment strategy in oncologic conditions for compliance with medical necessity and documentation requirements. It was added to the list of proposed RAC topics[1] Jan. 5 for outpatient hospital and professional service reviews. CMS also added the first 2021 audit targets to the approved list: Air Ambulance: Medical Necessity and Documentation Requirements,[2] Hospice Continuous Home Care: Medical Necessity and Documentation Requirements,[3] and Ambulance Transport Subject to SNF Consolidated Billing.[4]

Spinal Decompression Clinic of Texas (SDCT) agreed to pay $330,898 to settle false claims allegations for allegedly billing Medicare improperly for electro-acupuncture device neurostimulators, the U.S. Attorney’s Office for the Eastern District of Texas said Jan. 12.[5] SDCT charged Medicare for implanting 41 neurostimulators, which is a surgical procedure that usually requires an operating room, from Aug. 21, 2018, to June 26, 2019. Medicare paid SDCT $177,051 for these procedures. The U.S. attorney’s office alleged SDCT didn’t perform these surgeries, and instead applied P-Stim devices, a single-use, electric acupuncture device affixed behind a patient’s ear using an adhesive, in an office setting, without surgery or anesthesia. “Needles are inserted into the patient’s ear and affixed using another adhesive. Once activated, the device then provides intermittent stimulation by electrical pulses,” the U.S. attorney’s office said. “Medicare does not reimburse for acupuncture or for acupuncture devices such as P-Stim, nor does Medicare reimburse for P-Stim as a neurostimulator or as implantation of neurostimulator electrodes.” SDCT didn’t admit liability in the settlement.

Banner Health, on behalf of the Banner Health affiliated covered entities (Banner Health ACE), has agreed to pay $200,000 to settle potential violations of the HIPAA Privacy Rule’s right of access standard, the HHS Office for Civil Rights (OCR) said Jan. 12.[6] This is OCR’s 14th settlement under its Right of Access Initiative. OCR said it received two complaints against Phoenix-based Banner Health ACE about alleged violations. First a person alleged that she requested medical records in December 2017 and didn’t receive them until May 2018. In the second complaint, the person asked for an electronic copy of his records in September 2019, and they weren’t sent until February 2020. Banner didn’t admit liability in the settlement.

1 CMS, “2A261-Positron Emission Tomography (PET) for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements,” proposed RAC topic, January 5, 2021, http://go.cms.gov/3oMJeVb.
2 CMS, “0200-Air Ambulance: Medical Necessity and Documentation Requirements,” proposed RAC topic, January 5, 2021, http://go.cms.gov/35Jx1co.
3 CMS, “0201-Hospice Continuous Home Care: Medical Necessity and Documentation Requirements,” proposed RAC topic, January 5, 2021, http://go.cms.gov/3oRUyiY.
4 CMS, “0202- Ambulance Transport Subject to SNF Consolidated Billing,” proposed RAC topic, January 5, 2021, http://go.cms.gov/2LOMEbw.
5 Department of Justice, U.S. Attorney’s Office for the Eastern District of Texas, “Texas Company Agrees to Reimburse Medicare for Improper Billing Related to Neurostimulators,” news release, January 12, 2021, http://bit.ly/38IShkt.
6 HHS, “Banner Health Resolution Agreement and Corrective Action Plan,” resolution agreement, January 6, 2021, https://bit.ly/3oDYSSS.

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