In Miami, judges have begun sentencing defendants convicted of playing a role in the Medicare fraud scheme. The Department of Health and Human Services (HHS) has initiated the Healthcare Fraud Prevention and Enforcement Action Team (HEAT), which is aimed at reducing Medicare and Medicaid fraud. The indictments include, but are not limited to, conspiracy to […]
On Wednesday, the New York State Register published the new rules surrounding the New York Office of Medicaid Inspector General (“OMIG”) final rule on mandatory compliance programs, which enumerates specifics including who must comply and how to comply. The rules have also been published in the New York Code, Rules, and Regulations–18 NYCRR § 521. […]
On June 24, a federal grand jury in the Eastern District of Michigan indicted 53 Metro-Detroiters for allegedly submitting false Medicare claims totaling over $50 million. The sting operation undertaken by the Medicare Fraud Strike Force in Detroit, was coordinated by the Department of Health and Human Services Healthcare Fraud Prevention and Enforcement Action Team […]
Today, President Obama announced an $80 billion deal struck with the pharmaceutical industry. The deal involves the drug manufacturers taking steps to close the gap in the Medicare prescription drug coverage system, commonly known as the “doughnut hole.” According to President Obama, “Medicare covers up to $2,700 in yearly prescription costs and then stops, and […]
The Office of Inspector General (OIG) posted four audit reports as well as administrative and civil/criminal enforcement actions on Friday, June 19. The audit reports concern four separate situations: The University Medical Center of Southern Nevada billed Medicare improperly for two outpatient claims in 2004, resulting in an overpayment of about $22,000. In 2004 and […]
Governor Crist is at it again, signing more healthcare legislation into law. This time, Crist signed into law a bill that will “establish a statewide, comprehensive electronic system to monitor the prescribing and dispensing of controlled substances” that should be complete by June 30, 2010 (SB 462). The bill further states, “[e]ach time a controlled […]
On May 22, 2009, CMS published changes to the Medicare Benefit Policy Manual and Medicare Claims Processing Manual related to outpatient observation. The changes are set forth in Transmittal 1745 and will become effective July 1, 2009. The changes delete references to “admission” and “observation status” in relation to outpatient observation services. CMS acknowledged that […]
According to its most-recently published “Expansion Schedule,” the Centers for Medicare and Medicaid Services (CMS) planned to expand the Recovery Audit Contractor (RAC) program to 23 states by March 1, 2009, and the remaining states by August 1, 2009 or later. RAC automated reviews soon will begin, but medical necessity reviews have been delayed. On […]
Health Law Partners Adrienne Dresevic and Carey F. Kalmowitz published an article in Link, the American Healthcare Radiology Administrators (AHRA) member newsletter, which discusses current application of the Federal Stark law. The article addresses the In-Office Ancillary Services Exception (IOASE), which many office-based diagnostic imaging arrangements rely upon to enable referring physicians to provide ancillary […]
Over 250,000 Americans fall victim to medical identity theft each year, according to an article by the New York Times, and the increased use of electronic medical records with less than adequate privacy protection has allowed this number to rise. Medical identity theft is easily carried out when thieves attain someone’s name and Social Security […]
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