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States DO Have Rights…To Regulate Health Care Compliance
While it would be easy for physicians and facilities to focus most of their compliance time and dollars on learning new federal regulations and laws — from HIPAA’s privacy and security regs to the new health care reform legislation — don’t forget…
Continue reading...Hospital Settles Outlier Payments Case for $6.35 Million
27. March 2010
Case began as a qui tam, with some very familiar whistleblowers involved A New Jersey hospital agreed to pay $6.35 million last week “to settle allegations that the hospital defrauded Medicare,” according to
Continue reading...Quality Assurance: Does Your Hospital’s Peer Review Program Catch Unnecessary Surgeries & Procedures?
27. March 2010
Revamping this safety net protects patients and the hospital’s reputation and compliance record. Hospitals can sidestep a major patient safety and compliance nightmare: A physician who’s been doing procedures that clearly don’t meet established medical necessity criteria. That scenario occurred…
Continue reading...Hospital Risk Management: Head Off the Specter of Surgeons Performing Unneeded Procedures
22. March 2010
4 strategies can help, including knowing these key warning signs. Talk about a PR and legal disaster: Media reports that a prominent cardiologist at a hospital may have implanted stents in patients who didn’t need them. That scenario continues to…
Continue reading...OIG’s New ‘Compendium’ Reveals Possible Part A& B Audit Targets
22. March 2010
The OIG has combined the old red book and orange book to come up with a “Compendium of Unimplemented Recommendations,” the latest of which was published earlier this month. The document notes outstanding recommendations to save money in Medicare…
Continue reading...Don’t Misclassify Independent Contractors
15. March 2010
Make this mistake, and you’ll find sharper enforcement teeth from DOL, FLSA and the IRS. Yikes. If your home health or hospice company is trying to cut some corners by classifying some of its employees as “independent contractors,” watch out:…
Continue reading...Immigration Compliance: A Growing Concern for Health Care Employers
5. March 2010
Add “Department of Homeland Security” to the list of federal agencies who are interested in your health care organization’s compliance efforts. As if you didn’t have enough to keep an eye on with the EHR revolution, the health care reform…
Continue reading...Audits: RACs Pile On More Home Care Review Topics
1. March 2010
Think the Recovery Audit Contractors are sticking to big-money providers? Think again. Medicare’s audit bounty hunters may not yet have specified home health agency or hospice topics for review, but that doesn’t mean you have nothing to worry about from…
Continue reading...OIG Wants CMS to Train RACs to Spot Fraud
22. February 2010
Dirty little secret: The RACs flagged $1.03 billion in improper payments — and only 2 cases of fraud. If you’re wondering how often a Recovery Audit Contractor’s review of overpayments turns into a federal fraud investigation, a
Continue reading...Avoid ‘Patient Abandonment’ by Terminating Patient Relationships Carefully
22. February 2010
4 tips keep the trial attorneys, medical boards at bay. We recently addressed the question of what to do when a patient’s behavior endangers the rights of a health provider’s employees, specifically focusing on a…
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5. April 2010
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