According to a Department of Health and Human Services news release issued on Thursday, February 17, 2010, the Medicare Strike Force has indicted 111 health care providers for allegedly billing false claims to Medicare. HHS called this the “largest ever federal health care fraud takedown.” 21 defendants were arrested in…
Connolly Healthcare, the region C RAC, recently posted 77 new issues eligible for review. Twenty-three of these new issues involve Medical Necessity reviews, several of which include reviews of acute inpatient admissions to validate the medical necessity of short stay admissions. These new approved issues implicate a variety of MS-DRGs,…
Physicians should take note of the fact that Medicare’s electronic prescribing program, while offering incentives now, will soon be changed to a penalty system for those who do not adopt e-prescribing. Early adopters are currently being rewarded with a percentage of their total Medicare payments refunded to them. In 2011…
The OIG recently issued a favorable opinion concerning (1) the waiver of patient cost sharing amounts, without regard to patient need and (2) providing limited lodging and transportation for all patients of a network of pediatric charity hospitals. The requestors were pediatric non-profit charity hospitals which currently provide free services…
CVS recently settled a suit with the US Attorney’s office for allegedly having a disqualified pharmacist fill prescriptions in their New York and New Jersey stores. The settlement was for just under one million dollars. The pharmacist had been excluded from participating in federal programs and CVS failed to pick…
The Affordable Care Act requires that all home health and hospice services be initiated by an in-person encounter with the patient and their physician in order to be covered under Medicare. This requirement began January 1, 2011, but CMS has announced that it will not begin enforcing the requirement until…
The final rule changed several elements from the proposed rule. One changed feature under the final rule is that one entity will be responsible for testing EHRs, and another entity will be responsible for certifying the EHRs. No single entity will be allowed to perform both activities. Other changes involve…
Due to confusion surrounding whether an IDTF was considered a “mobile” or “fixed-base” delivery structure, the DAB has explicitly stated that there are two types of mobile IDTFs. Mobile IDTFs can either be “portable units” or a “mobile facility or unit.” The difference between the two definitions is that a…
The Adminstration has increased fraud prevention spending to $1.7 billion during the past fiscal year, a substantial increase from previous years. This increase has been used to combat the estimated $60 billion lost to fraud in any given year. The funds are going towards new law enforcement intra-agency teams called…
Time Magazine published an article on January 4 outlining the Federal Government’s increased measures to combat Medicare fraud. The article outlined that although there is not an official figure on the cost of government health program fraud, the National Health Care Anti-Fraud Association estimates that it is at least $60…