Region A: The RAC for Region A, DCS Healthcare, posted three new issues for non-medical necessity DRG validation inpatient claims review for providers in District of Columbia, Connecticut, Massachusetts, Maine, Delaware, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island, and Vermont. Region B: Region B’s RAC, CGI, added 20…
In a decision issued February 10, 2010, the Medicare Appeals Council reached a decision on an appeal from the RAC Demonstration Project. The Recovery Audit Contractor (RAC) initially found that the provider had received an overpayment for the inpatient services covered under Medicare Part A, but the beneficiary met the…
Yet another way that the Patient Protection and Affordable Care Act (the Act), otherwise known as the Health Reform bill, impacts health care providers is the strengthening of the Federal False Claims Act (FCA). For example, Section 6402 of the Act amends Section 1128 B of the Social Security Act…
The Patient Protection and Affordable Care Act, also known as the Healthcare Reform Bill, signed into law last week by President Obama, includes several provisions from the National Pain Care Policy Act. The National Pain Care Policy Act is legislation designed to improve pain care for the more than 76.5…
The U.S. Department of Justice (DOJ) and Rush University Medical Center agreed to settle a qui tam lawsuit alleging that Rush violated the Federal False Claims Act (FCA). The lawsuit, filed on July 12, 2004, alleged that Rush had violated the FCA by submitting certain false claims for payment to…
A bill in Florida’s Senate would target Medicaid fraud through the creation of a Fraud Strike Force and the expansion of the Medicaid Fraud Control Unit (MFCU) within the Florida Attorney General’s (AG’s) office. The Fraud Strike Force would direct state and local authorities to work together to more effectively…
Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS), announced $162 million in awards created to help states advance the meaningful use of health IT through state health information exchange. The awards are part of a $2 billion effort, funded by the American Recovery and Reinvestment…
The American Hospital Association (AHA) submitted comments to CMS on the proposed definition of “meaningful use” of Electronic Health Records (EHR). The Health Information Technology for Economic Clinical Health (HITECH) Act contains an EHR Incentive Program. That program is designed to encourage eligible providers to make “meaningful use” of EHR…
A New York Times article from March 15, 2010, documents the most serious problem with cuts to Medicaid payments to doctors: doctors dropping out of the program. The article focused on doctors in and around Flint, Michigan. According to the article, in 2008 Medicaid reimbursements averaged only 72 percent of…
The U.S. Department of Health and Human Services awarded the Michigan Department of Community Health (MDCH) and the Michigan Department of Information Technology (MDIT) a $14.9 million grant to encourage the expansion and success of health information technology (HIT) in Michigan. The funds, provided through the American Recovery and Reinvestment…