A shortage of primary care doctors has long concerned health policy experts, and the deficiency could grow even more severe if health insurance coverage is extended to more than 30 million Americans as expected under the new health care law. In response to the issue, the Obama administration began recruiting individuals to become “mystery shoppers” […]
The 2012 Michigan state budget, signed into law by Governor Rick Snyder on June 21, 2011, assumes the passage of the Health Insurance Claims Assessment Act. The proposed law involves a new 1 percent tax on paid health care claims and was introduced by the legislature as Senate Bill No. 348. The potential tax would […]
On June 21, 2011, the Departments of Justice and Health and Human Services (“HHS”) announced that Maria Haber, an owner of a medical clinic based in Metro Detroit, was sentenced for her involvement in a $1.12 million Medicare fraud scheme. Haber’s penalty includes 15 months in prison, 3 years of supervised release, and over $1 […]
On June 17, 2011, the Centers for Medicare & Medicaid Services (“CMS”) announced that beginning July 1, 2011 it will start to utilize an innovative predictive modeling technology to aid the prevention of Medicare fraud. This CMS announcement comes in the wake of Obama’s Campaign to Cut Waste launch. The predictive modeling technology should help […]
Large commercial companies have never fared well when offering kickbacks to physicians. Historically, regulators have aggressively pursued such wrongdoers for their attempts to interfere with sound medical judgment. Physicians, on the other hand, have often gone unprosecuted for their involvement in kickback schemes. However, according to the general counsel to the Department of Health and […]
On June 21, 2011, the Office of Inspector General of the U.S. Department of Health and Human Services (“OIG”) posted Advisory Opinion No. 11-08. This Opinion addresses possible federal Anti-Kickback Statute sanctions for payments made by a Medicare DME Supplier to a Medicare sleep test provider for storing the Supplier’s PAP equipment and supplies and […]
MedPAC released its highly anticipated proposal calling for a reduction in the use of imaging services, including MRIs, CT scans and nuclear medicine, and, in particular, recommended pre-authorization for medical imaging services as a means to accomplish this objective. The MedPAC report focuses, in particular, on physicians who order an inordinately high volume of imaging […]
In reviewing certain inpatient hospital claims, the RAC for Region B (covering the Midwestern states), CGI, and its subcontractor, PRG Schultz, are now requesting that nursing notes not be included in response to additional documentation requests (“ADRs”). Note that this directive is not consistent across all ADRs, as other ADRs specifically ask for nursing records. […]
The Medical Group Management Association (“MGMA”) recently released the result highlights of the largest physician compensation survey in the United States. The survey is based on 2010 data from 60,000 providers in more than 150 specialties; the publically reported figures focus on 15 specialties. According to the selected specialties data, orthopedic surgeons were the highest […]
In addition to the multitude of auditing activities and programs that exist, the Medicare Carriers/Medicare Administrative Contractors also conduct medical reviews. Like many other auditing programs, these probe reviews are data driven and are conducted for the purpose of validating potential provider billing errors. The process may include either provider or service specific reviews. The […]
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