Physicians Health Plan will be the insurer to offer subsidized health coverage for chronically-ill Michigan residents. The insurer, based in Lansing, will offer health coverage through the health insurance pool that was created to provide an avenue for the uninsured chronically ill to buy coverage until state exchanges are active…
The Detroit Free Press reported that a Michigan doctor was sentenced to 14 years in prison for Medicare fraud. In addition to the prison sentence, the doctor will owe $9.4 million in restitution payments and is eligible for a three-year supervised release after his prison sentence. According to the Department…
The Office of Inspector General (OIG) published two reports targeting inpatient rehabilitation facilities (IRF). Most notable, however, is the CMS response to the OIG reports. The first report reviewed IRF transmission of patient assessment instruments for calendar years (CY) 2006 and 2007. This report showed that IRFs failed to timely…
As part of the Patient Protection and Affordable Care Act (PPACA), i.e., health care reform, states received more than $46 million in grants from the U.S. Department of Health and Human Services (HHS). Crain’s Detroit Business reported that Michigan has received $1 million of grants from HHS to go towards…
The OIG recently published a report showing that from 2006 to 2008, Medicare allowed $2.2 million for routine maintenance and servicing of capped rental durable medical equipment (DME) with rental periods. These payments were erroneously made because the Deficit Reduction Act of 2005 (DRA) dramatically limited, if not eliminated, routine…
The Department of Health and Human Services Office of Inspector General (OIG) published a report finding that Medicare contractors overpaid physicians an estimated $13.8 million for services provided during calendar year 2007 with incorrect place of service codes. The OIG report reminded physicians that they must identify the place of…
The Centers for Medicare and Medicaid Services recently published an MLN Matters Article regarding the length of time physicians are required to retain documentation. The article reiterated that the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires a covered entity to retain required documentation for six years from…
The American Hospital Association (AHA) reported on August 10 that the Centers for Medicare and Medicaid Services (CMS) have approved “medical necessity review” audits for the Recovery Audit Contractor (RAC) program. According to the AHA, the approved audits include 18 types of inpatient hospital claims and one type of durable…
The Office of Inspector General (OIG) for the Department of Health and Human Services recently announced a discovery that during the time period from July 15, 2010 through August 4, 2010 the search/verification function on the online searchable List of Excluded Individuals/Entities (LEIE) was not working properly. Therefore, health care…
Michigan’s Attorney General Mike Cox announced a community forum to be held next week regarding the proposed sale of the Detroit Medical Center to Vanguard Health Systems, Inc. Earlier this year, DMC signed a purchase agreement that would require Vanguard to make $850 million in capital improvements over the next…