OIG Requests $40+ Million More Funds to Beef Up Fraud Detection
Note to physicians: Ratchet up your documentation skills now. The OIG has been on a roll over the past year, and they don’t intend to slow down anytime soon. The agency has requested an additional $41.5 million from the 2011 federal budget to help its efforts. According to a 38-page report issued by Inspector General Daniel Levinson, [...]
Continue reading...1. February 2010
J&J PowerPoint Kickback Case Lesson: Keep Those Intentions Clean!
3 precautions every provider should take when presenting finanicials. The feds continue to hassle Johnson & Johnson and Omnicare for their financial relationship, and now they’ve got a PowerPoint presentation to add to their contention that J&J violated the False Claims Act when it attempted to influence the prescribing of J&J drugs. The case contains some important [...]
Continue reading...8. February 2010
Do ALJ or DAB Rulings Indicate Whether IJ Citations Should Involve Actual Harm?
Question: I’m a new administrator for a nursing home and am surprised that we can get an immediate jeopardy citation for an issue that doesn’t really cause harm. Are there any administrative law judge rulings or Departmental Appeals Board decisions that say that immediate jeopardy citations should involve actual harm to one or more patients? [...]
Continue reading...8. February 2010
No Red Flags Rule for Health Care Providers?
A recent legal victory for lawyers may mean less regulatory paperwork for you. The American Bar Association has won a lawsuit against the Federal Trade Commission that will exclude ABA members from Red Flags Rule enforcement. Now health care provider trade groups are citing the ABA’s victory in a bid to gain their own exclusion from the rule that will require providers to have identity theft protection programs [...]
Continue reading...8. February 2010
4 Hospice Compliance Hotspots You Must Watch
Take special care in hospice/nursing home arrangements. The OIG has hospice agencies in its sites with over two dozen areas on its watch list. Tighten up your compliance plan to make sure your compliance plan is covering all the bases. Hold the Rewards for Referral Sources The OIG has identified 28 total risk areas for abuse in hospice [...]
Continue reading...1. February 2010
Do My Physician’s SNF Claims Violate Stark Laws?
What’s the road to compliance when a SNF’s medical director also bills fee-for-service? Question: My physician is the medical director for a skilled nursing facility and receives a stipend from the SNF for that service. Can he still bill for services he provides to the SNF’s patients? Answer: Since you’re dealing with directorship of the skilled nursing [...]
Continue reading...1. February 2010
HIPAA Compliance: How to Craft an Airtight Breach Notification Policy
Start with this handy checklist for breach notification policies and procedures. We recently covered the steps your facility or practice needs to take to get ready for the February 22 enforcement deadline for the ARRA/HITECH breach notification regulations. Now that you’ve got a good overview of the process, it’s time to focus on creating a specific [...]
Continue reading...31. January 2010
Organized Crime Turns to Health Care Fraud
Mobsters see home health care as a happy hunting ground for ill-gotten gains. The fact that federal fraud fighters recover $4 billion a year in false claims sounds pretty impressive — until you consider that Medicare & Medicaid fraudsters rake in an estimated $60 billion a year. Big potential profits are why organized crime is moving in [...]
Continue reading...24. January 2010
Hospital System Admits Errors, See Benefits All Around
What happens when a formal trial lawyer becomes a risk manager? One hospital is lifting the veil of secrecy that has traditionally surrounded patient claims and litigation and makes it a policy to apologize for errors and support its staff in doing so. While it may be a special case as an integrated system with favorable [...]
Continue reading...24. January 2010
Prepare for Feb. 22 Enforcement of Security Breach Regs with These 5 Steps
Your facility or office has taken the advice of experts and crafted a security management process that protects the confidentiality of the personal health information in your patients’ records. You believe you are compliant with ARRA and HITECH’s changes to HIPAA. But are you ready for February 22? That’s the day that the ARRA/HITECH’s breach [...]
Continue reading...24. January 2010
Overpayments: What Are My Compliance Obligations?
Can insurers deduct overpayments from your checks? Find out here. Question: Some insurers are deducting overpayments from our checks for visits or services rendered. Are payers allowed to do this, and do we really have to pay back overpayments? Answer: As a healthcare provider, you’re legally obligated to repay overpayments when you or the payer discovers the [...]
Continue reading...18. January 2010
OIG 2010 Work Plan Alerts Hospitals to Hot Compliance Areas
POA, PHI & adverse events will be hot spots this year. Make sure your hospital is ready for the new year by studying the HHS OIG’s 2010 Work Plan, which experts say includes a range of compliance hot spots that can turn into traps for unwary facilities that serve Medicare and Medicaid patients. Hospitals should focus on [...]
Continue reading...- Audit Alert: Ambulance Services for Part A SNF Residents
- Some Flowers & Some PHI
- Feds Pinpoint Therapy in Major NPP Incident To Snafus
- Senior Medicare Patrol Recovered $4.5 Million by Watching for Fraud and Abuse
- Organized Crime Turns to Health Care Fraud
- HHS Investigates Humana For Scary Flyer
- OIG Settlement Highlights Personal Accountability for Compliance Officers, CEOs
- Keep Staff Up to Date on CPR, Physical Restraint Policies
- Prepare for Increased Fraud Enforcement with Medicaid Compliance Plan
- HHS Issues New Interim Rule on HIPAA Penalties
- Editor: Hi Gary: Thanks for writing in. I didn't deal too ...
- Gary Brazzell: Unfortunately, to me, this story is a little fuzzy...
- HIPAA Privacy Security Expert: Hi, I would also like to further add few points...
- Kauian HME: In rural areas like ours, access to care for Medic...
- Gerald W. Bolton: One thing very which we found out on our behaviora...
- OIG Requests $40+ Million More Funds to Beef Up Fraud Detection
- J&J PowerPoint Kickback Case Lesson: Keep Those Intentions Clean!
- HIPAA Gets More Heft
- DME: OIG Finds 60% Of Wheelchair Claims Don’t Meet Medicare Requirements
- States Crack Down On Medication Disposal: How To Comply
- 15-Bed Hospital, Physician Settle Medical Necessity Qui Tam Case
- Keep Staff Up to Date on CPR, Physical Restraint Policies
- Medicare Strike Force Update: Brooklyn, Tampa & Baton Rouge HEAT Up
- Children on Medicaid More Likely to Take Antipyschotics
- OIG Investigates DME More Than Any Other Provider Type
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8. February 2010
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