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CMS 2019 Medicare Fee Schedule Designed to Reduce Administrative Burdens

The Centers for Medicare & Medicaid Services (CMS) has released its 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule, which the agency says will “address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices.” However, a controversial payment component of the plan will be delayed […]

CMS to Draft Rule Requiring Prior Authorization for Chiropractors

Look for a proposed rule later this year that could make it harder for some chiropractors to submit Medicare claims. The Centers for Medicare & Medical Services is looking to require chiropractors with high rates of claim denials to obtain prior authorization before treating a patient. Chiropractors impacted will have to submit a request for […]

CMS Proposes Changes Designed to Speed up Medicare Appeals Process

It’s been a while since we last updated you on the latest about the Medicare appeals backlog, which although it has decreased some, remains troublesome. To further address the issue, The Centers for Medicare & Medicaid recently proposed revising its rules that govern the appeals process in an effort to further streamline it and reduce […]

Healthcare exec pleads guilty to multimillion-dollar opioid scheme

A Michigan healthcare CEO recently pleaded guilty to taking part in a $300 million healthcare fraud scheme that, in the words of U.S. Attorney Jeff Sessions, “flooded the streets” with millions of doses of opioids and other controlled substances. Mashiyat Rashid was CEO of the Tri-County Wellness Group of medical providers which operated pain clinics […]

OIG Unveils Fraud Risk Indicator

The Health and Human Services Office of Inspector General has launched a new initiative designed to draw attention to those healthcare providers it considers to be high risk for committing healthcare fraud after having been charged under the False Claims Act. The OIG posted this Fraud Risk Indicator on its website after Gregory Demske, the […]

Tis the Season: Gifts to Medicare Patients Nice Gesture or a Crime?

As we approach the holidays, now may be an appropriate time to point out the rules relating to gifts that providers can give to Medicare and Medicaid beneficiaries. During this time of the year, some healthcare professionals may want to give gifts to their patients, other physicians or even referral sources. Before you do, consider […]

Obstructing Medicare Audit Can Get You Jail Time

A 73-year-old Port Charlotte, Florida endocrinologist was recently sentenced to five months in prison, to be followed by three years of supervised release, for obstructing a Medicare audit. In addition, Dr. John Janick will have to pay $118,831.62 in restitution to the Medicare program. Janick, who reached a plea agreement, is alleged to have lied […]

How an Innocent Social Media Post Can Turn Into a HIPAA Violation

A Texas nurse recently learned that you don’t have to identify a patient by name to violate Health Insurance Portability and Accountability Act (HIPAA) rules. According to a number of published reports, the unidentified woman, who worked as an ICU/ER  nurse, was fired from her job with Texas Children’s Hospital in Houston after posting about […]

Opioid Crackdown Nets South Florida Doctor as Efforts Intensify

A South Florida doctor is the latest to be sentenced for his role in the illegal distribution of opioids. Earlier this month, Dr. Andres Mencia of Fort Lauderdale was sentenced to more than six years in prison, after being convicted by a federal jury of taking part in a conspiracy to distribute a controlled substance. […]

OIG Wants Input on Changes to Anti-kickback Statute and CMP

The U.S. Department of Health and Human Services Office of the Inspector General is looking for ways to encourage and incentivize coordinated care, without violating the Anti-kickback Statute and Civil Monetary Penalties Law. The CMP imposes penalties against those who offer or transfer remuneration to a Medicare or state healthcare program beneficiary to influence the […]

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It is not intended as professional advice and should not be construed as such.