Alleging False Claims Act, Stark Law, and Anti-Kickback violations, the University of Medicine and Dentistry of New Jersey (UMDNJ) settled with the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) for $8.3 million–double what Medicare paid for the allegedly improper referrals. UMDNJ is licensed as a Level I Trauma Center. […]
The OIG released its Work Plan for the 2010 fiscal year (FY) this week, to be effective beginning October 2009. The OIG’s Work Plan “describes the specific audits and evaluations that [the OIG has] underway or plan[s] to initiate in the FY ahead….The Work Plan also provides focus areas for [the OIG’s] investigative, enforcement, and […]
When a beneficiary elects hospice care, s/he waives any Part B coverage related to that hospice care except for services rendered by an “attending physician.” An attending physician is defined as either a doctor of medicine, doctor of osteopathy or a nurse practitioner who is identified by the beneficiary as having the most significant role […]
On September 22, 2009, the U.S. Senate’s Chairman’s Mark released a draft legislation regarding the future of healthcare in the United States. Some notable points include: – Limiting physician referrals only to permit hospitals that meet certain exemption requirements, which would be more stringent than the current Medicare requirements; – Establishing a process to update […]
Arizona Heart Hospital agreed to settle with the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) for $675,000 for 10 instances of filing false claims with Medicare. According to the OIG and HHS, between July 2005 and March 2007, physicians at Arizona Heart Hospital submitted claims for carotid artery […]
OIG released two reports examining the hospice benefit for residents of a nursing care facility. The first report, “determined the extent to which hospice claims for beneficiaries in nursing facilities met Medicare coverage requirements.” According to Section 418 of Title 42 of the Code of Federal Regulation, to receive Medicare coverage for delivering hospice care […]
The HITECH Act (The Health Information Technology for Economic and Clinical Health Act), enacted February 17, 2009, significantly supplemented and altered the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). One such provision of the HITECH Act made both covered entities and their business associates liable for breaches of patients’ unsecured protected health information […]
Centers for Medicare and Medicaid Services (CMS) noted that consignment closets (also known as stock and bill arrangements) have not complied with durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier standards. As a result, CMS issued a Change Request (CR) affecting physicians and DMEPOS suppliers, which allows for consignment closets only when all of […]
The Recovery Audit Contractor (“RAC”) for region D, HealthDataInsights, Inc. recently published its RAC website, and published its first list of approved RAC audit issues for complex coding reviews. Pursuant to the recently-published CMS RAC Review Phase In Strategy, complex reviews regarding DRG validation and coding errors were scheduled to begin in August or September […]
OIG recommends revision of the “incident to” rule. The Office of Inspector General (OIG) released a report, “Prevalence and Qualifications of Nonphysicians Who Performed Medicare Physician Services” analyzing services that nonphysicians perform for which physicians bill Medicare. The “incident to” rule involves physicians billing for nonphysician-rendered services that are compensated under Medicare Part B. Nonphysicians […]
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