HC Compliance Essentials

What Are the Compliance Guidelines for New Patient Freebies?

Question: What kind of gift can a provider give new patients? Can the provider advertise an iPod for every new braces patient, for example? Answer: If the patient is not a Medicare or Medicaid beneficiary, you don’t…

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PT Pleads Guilty to Falsifying Medicare Claims

A Detroit-area physical therapist (PT) has learned the hard way that fraudulently billing Medicare will eventually catch up with you. According to an Aug. 26 press release from the FBI’s Detroit office, the PT pleaded…

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NJ Practice Busted for Providing PT, Claiming Surgeries

Modifier misuse, POS coding errors might be partly responsible for one physician’s legal troubles. A New Jersey practice allegedly overbilled Medicare by almost $5 million by fraudulently reporting lymphedema procedures to its carrier. Although the practice billed for surgery that…

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6 Steps for Successful Physician Self-Audits

With all the attention lately on fraud and abuse issues in Medicare, many physician practices are ready to plan for their first self-audit but aren’t sure where they should begin. We’ve got six important tips that can help first-timers get…

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Look for RACs to Target Ultrasound Claims

Plus: The OIG identifies 20 counties it classifies as “high use” for ultrasounds. The OIG is watching ultrasound claims – and it doesn’t like what it sees. An OIG audit of ultrasound services billed in 2007 found that nearly one…

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McAllen, TX: Do Stark Loopholes Cause Overutilization?

A recent New Yorker article on health care utilization patterns in McAllen, TX has become ‘required reading’ for White House policy wonks. President Obama himself has mentioned the article in a couple recent speeches. Why compliance professionals should care: Dr.…

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