A common reason for claim denials through the Comprehensive Error Testing (“CERT”) program and the medical review process is a lack of provider signatures on orders and medical documentation. Medicare requires that services provided and/or ordered be authenticated by the author. The method of authentication must be a handwritten or…
In its over-300-page complaint filed on 8/19/2011, GEICO General Insurance Company, et. al (hereinafter referred to as “GEICO”) asserts that the 32 defendants named in this case–13 physicians, 18 entities, and 1 entity owner– (“Defendants”) defrauded GEICO in an amount in excess of $12.1 million under New York’s No-Fault Insurance…
In a press release issued August 22, 2011, New York State Comptroller, Thomas DiNapoli, announced that New York State stopped or recovered more than $2.3 million in Medicaid overpayments after an audit of the Department of Health’s eMedNY computer payment system. The Comptroller’s Office oversees the financial affairs of New…
The Health Information Technology for Economic and Clinical Health Act (“HITECH”) requires the Office of Civil Rights (“OCR”) to conduct periodic audits of covered entities in connection with complying with the privacy and security requirements set forth in Health Insurance Portability and Accountability Act (“HIPAA”). In June, the OCR awarded…
In a press release issued by the US Department of Justice of the Eastern District of Pennsylvania, a 498-count indictment–240 counts of which involved healthcare fraud–charged 53 defendants, including a physician and pharmacist, in a multi-million dollar drug conspiracy. The press release states that William Stukes–a drug trafficker of Philadelphia–and…
In an August 1, 2011 letter to the U.S. Department of Health and Human Services Secretary, Kathleen Sebelius, the American Hospital Association (“AHA”) urges the Centers for Medicare and Medicaid Services (“CMS”) to reevaluate its HIPAA Privacy Rule Accounting of Disclosures Proposed Rulemaking (“Proposed Rule”). The AHA is the latest…
Medicare beneficiaries with a terminal illness may choose to receive palliative care instead of curative treatment under the Medicare hospice benefit. In recent years, the Office of Inspector General (“OIG”) has raised some concerns about the Medicare hospice care received by nursing facility residents. As a result, a number of…
The Centers for Medicare & Medicaid Services (“CMS”) recently released the final regulation regarding the hospice wage index for the fiscal year (“FY”) 2012 (“Final Rule”). As a result of the Final Rule, a 2.5 percent increase in Medicare payments to hospices serving Medicare patients will be implemented for FY…
On July 28, 2011, the House Oversight and Government Reform Committee held a hearing on Improper Medicare Payments. The hearing highlights the ongoing friction between providers and recovery audit contractors (RACs) and the fact that the Centers for Medicare and Medicaid Services (CMS) is continuing their effort to combat fraud…
On July 21, 2011, the Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) announced that Administrative Law Judge (ALJ) Steven T. Kessel upheld OIG’s exclusion of Michael D. Dinkel from participation in all Federal health care programs under section 1128(b)(7) of the Social Security…