The Master List for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) comes from a November 2019 final rule that created the list to serve as a library of items that have been identified as potential...more
A March 11 article in Part B News, “Warning: Minor Errors Can Mean Big Takebacks for AWV Claims,” discussed how compliance shortcomings can cause problems for claims to Medicare for annual wellness visits (AWVs). Rivkin...more
When it comes to mitigating the risk of class action lawsuits, the best offense is a good defense. Companies can take many steps to reduce their exposure to class action litigation before it happens, including the tactics...more
Moffitt Cancer Center’s recent $19.5 million settlement with the U.S. Department of Justice (DOJ) and the state of Florida resolving allegations that billing errors violated the False Claims Act (FCA) triggered a “fully...more
Ultragenyx to Pay $6 Million To Settle False Claims Act Case - Ultragenyx Pharmaceutical Inc. recently agreed to pay $6 million to settle a qui tam action filed under the False Claims Act (FCA). Ultragenyx manufactures a...more
The CFPB settled a lawsuit originally filed in January 2020 against a large national bank, claiming it violated the Truth in Lending Act and its implementing Regulation Z, as well as the Consumer Financial Protection Act, by...more
With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid...more
CT magazine (August 2022) - Medical school curriculum is heavy in anatomy, physiology, biochemistry, pathology, and clinical rotations or clerkships. There is very little, if any, instruction on proper coding and billing...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
Report on Medicare Compliance Volume 29, no. 32 (September 14, 2020) - In an audit of 100 outlier payments, the HHS Office of Inspector General (OIG) said Baylor Scott & White – College Station, a hospital in Texas, didn’t...more
On May 13, 2020, the Consumer Financial Protection Bureau (CFPB) issued a Statement on Supervisory and Enforcement Practices Regarding Regulation Z Billing Error Resolution Timeframes in Light of the COVID-19 Pandemic...more
The CFPB has issued a statement regarding its supervisory and enforcement approach to Regulation Z billing error resolution timeframes in light of the COVID-19 pandemic....more
Report on Medicare Compliance 29, no. 16 (April 27, 2020) - The HHS Office of Inspector General (OIG) has proposed a rule on civil monetary penalties (CMPs) for information blocking and fraud related to HHS grants, contracts...more
Last week, the Court of Appeal gave a victory to non-contracted providers of emergency medical services. In San Jose Neurospine v. Aetna Health of California, the court rejected Aetna's position that because the provider "did...more
Report on Medicare Compliance 29, no. 5 (February 10, 2020) - At least two Medicare administrative contractors (MACs) have set their sights on observation services, and there may be more to come. WPS is auditing...more
Compliance Today, December 2019 - According to a recent MLN Connects notice, “A recent Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using...more
Report on Patient Privacy 19, no. 12 (December 2019) - Sentara Hospitals, a nonprofit group of 12 medical centers in Virginia and North Carolina, will implement a fairly minimal two-year corrective action plan (CAP) and...more