The Government Accountability Office released a report on March 2, 2011, which concludes that inefficiencies and duplication in Government Programs are costing taxpayers billions every year. This report, entitled “Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars and Enhance Revenue,” was issued to aid lawmakers in setting the federal…
The Justice Department is seeking clarification on a ruling made by U.S. District Court Judge Roger Vinson. Judge Vinson, in his ruling on the implementation of the Patient Protection and Affordable Care Act, suggested that the government was enjoined from implementation of the Act. The DOJ now wants the Judge…
CGI, the Recovery Audit Contractor (RAC) for Region B, recently removed four DRG validation issues from its list. This means that providers in Region B will no longer be subject to RAC audits on these particular procedures. Connolly has added several new RAC issues to its CMS approved list. One…
Effective February 14, 2011, CMS has limited the number of records RACs may request when reviewing Medicare claims from Physicians and other practitioners. These requests for medical records, which are used in connection with complex claims reviews, will be limited based on the size of the group/office being audited. If…
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…