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Report: Many High-Risk Medicaid Providers Not Undergoing Critical Background Checks

Eighteen states failed to properly screen high-risk providers before allowing them to receive Medicaid payments by the July 2018 deadline and 13 of those states had not yet complied by Jan. 1, 2019. Those are the findings from a recently released report by the U.S. Department of Health and Human Services Office of Inspector General. […]

Growth of Telemedicine Sees Increase in Healthcare Fraud

Earlier this month, a New York anesthesiologist was indicted on charges stemming from her role in an alleged telemedicine conspiracy to submit fraudulent claims to federal and private insurance plans. The indictment alleges that Anna Steiner, also known as Hanna Wasielewska, along with others, ordered and prescribed durable medical equipment (DME) and prescription drugs in […]

New Telehealth Law Takes Effect in Florida

On June 25, Florida Governor Ron DeSantis signed into law HB 23, which sets up guidelines for telehealth services in Florida. The legislation took effect July 1. Among other things, the law creates new practice standards for how telehealth can be used and by whom, registration of out-of-state telehealth providers, where telehealth services can be […]

HIPAA Violations Result in More Than Fines: Beware of Jail Time

Late last month, the U.S. Department of Justice announced that a 62-year-old woman would be spending a year behind bars after being convicted of disclosing the health information of two people “with the intent to cause them embarrassment and mental distress.” Linda Sue Kalina worked from March 7, 2016 through June 23, 2017 as a […]

Inpatient Providers Settle Payment Dispute with CMS over Medicare Claims

The Centers for Medicare & Medicaid Services (CMS) has ended a two-year dispute settling appeals from inpatient rehabilitation facilities (IRF) over Medicare claims that were denied. The agency has agreed to pay 69 percent of the net payable amount for most claims that are pending appeal before the Medicare Administrative Contractor (MAC), the Qualified Independent […]

OCR Fact Sheet Clarifies BA Liability Under HIPAA

The U.S. Department of Health and Human Services Office for Civil Rights recently issued a new fact sheet on the Direct Liability of Business Associates under HIPAA. The release of the fact sheet immediately followed a settlement agreement with a business associate relating to a data breach that occurred in 2015 when hackers used a […]

OIG Alert: Beware of Genetic Testing Scam

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) recently sent out an alert about a fraud scheme involving genetic testing. The government watchdog agency said Medicare beneficiaries are being offered the chance to get tested for certain genetic conditions through the use of a simple cheek swab, but they […]

OIG Cracks Down on Home Health Questionable Billing Practices

A few years back, as part of its Work Plan, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) announced it was seeking to identify home health agencies, supervising physicians, and geographic areas whose Medicare claims had characteristics similar to those observed by the agency in cases of home health […]

Incident-to Billing Investigation Ends in $118,000 Fine

A physician in Texarkana, Texas recently agreed to pay $118,000 to settle allegations he engaged in improper billing practices for his Medicare patients at three of his clinics. According to the allegations, Dr. Donald S. Douglas’ advanced practice nurses (APNs) were hired to assist him with seeing patients in his clinics. By law, if the […]

Florida’s Behavior Analysts Make Some Strides

Last month, we wrote about Florida’s Agency for Health Care Administration (AHCA) decision to postpone planned cuts to Medicaid reimbursement rates for behavioral health therapists. But at that time, AHCA did not specify for how long the postponement would last. Now, we learn from the Florida Association for Behavior Analysis that the Florida Legislature is […]

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