As we reported in a previous blog entry, HHS recently encouraged prescription drug plans to delay the payment of suspicious claims and to take proactive measures to prevent prescription drug fraud such as requiring pre-authorizations and limiting payment of controlled substances beyond a thirty-day supply . Now, it seems that CVS has decided to take […]
OIG recently issued an alert for physicians who reassign their right to bill the Medicare program and receive Medicare payments by executing the CMS-855R application, which says they may be liable for false claims submitted by entities to which they have reassigned their Medicare benefits. OIG has advised physicians to use increased scrutiny of entities […]
On February 8, 2012, the Office of Inspector General published the November and December Recovery Act Oversight Monthly Reports. The most recent figures indicate that in November 2011, $12,589,859.00 dollars of Recovery Act funds were used on Recovery Audit activities. In December 2011, $13,161,164.00 dollars of Recovery Act funds were used on Recovery Audit activities. […]
Recently the OIG released the 7th of 11 videos that cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises. The videos are from the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. Compliance Programs, simply […]
When a patient presents at an emergency department of a hospital, they are evaluated by a ER physician to determine whether they should be admitted as inpatient or outpatient observation. An inpatient admission occurs when a person is admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services. The criteria when […]
Modern Healthcare reports that two anti-fraud demonstration projects announced in November by CMS were delayed after they drew heavy provider opposition. The first project would require pre-authorization for scooters and power wheelchairs prescribed to Medicare beneficiaries in any of the seven states with the highest concentration of fraud or billing errors, including, California, Michigan, New […]
On December 30, 2011, CMS issued an informational bulletin CPI-B 12-01 entitled, Affordable Care Act Program integrity Provisions – Guidance to States – Section 6411(a) – Expansion of the Recovery Audit Contractor (RAC) Program to Medicaid (“Bulletin”). By way of brief background, Section 6411(a) of the Patient Protection and Affordable Care Act (“PPACA”) expands the […]
Hospice provider AseraCare is accused of submitting “false and fraudulent” Medicare claims for payment to the U.S. It has been alleged that the hospice has been claiming charges to the Federal Government for those patients who were not admitted to hospice. Hospice care is provided to Medicare recipients who have a prognosis of six months […]
Due to the “significant program integrity problems” presented to the Medicare program by durable medical equipment, prosthetics, orthotics, and supplies (“DMEPOS”) suppliers, the Office of Inspector General (“OIG”) issued a report, Program Integrity Problems with Newly Enrolled Medicare Equipment Suppliers (“Report”). In its Report, the OIG aimed describes the aim of its investigation was two-fold: […]
In the December 19, 2011 Federal Register, the Centers for Medicare and Medicaid Services (“CMS”) issued its proposed rule for the Physician Payments Sunshine Act (“Proposed Rule”), which was promulgated as a result of Section 6002 of the Patient Protection and Affordable Care Act (“PPACA”). Section 6002 requires applicable manufacturers of drugs, devices, biological, or […]
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