Elizabeth L. Johnson, a former New York pharmacist was charged with grand larceny, offering a false instrument for filing and unauthorized practice for her allegations that she defrauded Medicaid out of approximately $191,000. While Johnson’s license to practice as a pharmacist was suspended and she was excluded from participating in…
Today, the Office of Inspector General (OIG) released supplemental materials for its Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse, which include a companion PowerPoint presentation, a speaker note set to assist in presenting the PowerPoint presentation and a narration of the speaker’s notes. All of these…
Wisconsin Physician Services (“WPS”), the Medicare Part B Carrier for providers in Michigan, Illinois, Minnesota and Wisconsin, recently conducted a service-specific probe review of Current Procedural Terminology (“CPT”) 99233 billed by neurology providers. WPS found that only 4 percent of billed claims were payable. 96 percent were denied or down-coded.…
The recovery audit contractor (“RAC”) for Region B covering the Midwestern states, CGI Federal, Inc., is requesting additional documentation from providers regarding facet joint injections without reported imaging guidance (CPT codes 64470-64476). The requests for additional documentation acknowledge that CMS has not yet approved this issue for complex review and…
On February 2, 2011, the OIG published its findings from an audit conducted of Prescription Drug Event (PDE) records obtained from Medicare Part D sponsors for Schedule II drugs. A copy of the report can be found at: http://go.usa.gov/Ydd. A significant number of PDE records contained invalid prescriber identifiers which…
In an Office of Inspector General (OIG) press release, the OIG announced its first-ever Most Wanted Healthcare Fugitives List, which includes photos and profiles for each fugitive. According to the press release, “the 10 individuals on the Most Wanted Health Care Fugitives List have allegedly cost tax payers more than…
In light of recent campaign promises, Congressional Republicans have pushed to quash the Affordable Care Act, commonly known as the healthcare reform law or “Obamacare.” On January 20, the US House of Representatives voted 245-189 to repeal the Affordable Care Act while yesterday, Senate Democrats, by a 51-47 vote, defeated…
A report published in the February 2, 2011 edition of the Journal of the American Medical Association, compared the patient diagnoses, length of stay, and location of service for hospice patients receiving care from for-profit and not-for-profit hospices. The researchers found that for-profit hospices had a higher percentage of patients…
CMS has issued revised Interpretive Guidelines for the Hospital Conditions of Participation. The revised Interpretive Guidelines, which are effective immediately, contain significant changes affecting anesthesia providers, including the following: • Labor Epidurals. CMS removed language exempting labor epidurals from the physician supervision requirements. The revised Interpretive Guidelines note that, “there…
During the Recovery Audit Contractor (“RAC”) demonstration program, a significant number of the claims denied were denied for the reason that an inpatient hospital admission was not medically necessary. The RACs regularly based these denials not upon published Medicare guidance, but based upon the criteria of private companies, such as…