Government cracks down on pharmacies, home health agencies, medical directors for medically unnecessary services

It’s no secret that in recent years the number of healthcare fraud investigations and prosecutions in the U.S. has rocketed. Clearly, the amount of taxpayer dollars being lost to fraud and abuse, coupled with the potential for big payoffs when fraud is detected, is a great motivator. Every year that the government racks up successful […]

Doctor, patient frustration over pain med access leads to pharmacy rule change

The Florida Board of Pharmacy recently approved a rule change designed to help patients get the pain medications they need. The rule, which grew out of claims from frustrated patients and their physicians, is aimed at training pharmacists to change the way they look at prescribing controlled substances – from one of finding reasons to […]

Renewed efforts underway to allow ARNPs and PAs to prescribe controlled substances

There’s another effort afoot in Tallahassee to allow Physician Assistants (PA) and Advanced Registered Nurse Practitioners (ARNP) to write prescriptions. Rep. Cary Pigman, a Republican from Avon Park, has filed a bill (HB 423) that would allow these practitioners to prescribe controlled substances without the direct supervision of a physician, something they are prohibited from […]

Feds to increase exclusion and civil monetary penalty enforcement cases

When it comes to exclusion and civil monetary penalty cases, the federal government is preparing to take an even harder line than in the past. During the recent Health Care Compliance Association’s Healthcare Enforcement Compliance Institute, Gregory Demske, chief counsel at the Health and Human Services Office of Inspector General, told an audience his agency […]

OIG opinion: Free transportation doesn’t violate anti-kickback statute

The U.S. Department of Health and Human Services Office of Inspector General recently issued an opinion stating that a large healthcare system’s free van shuttle service for patients does not violate the federal anti-kickback statute. The statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce […]

How whistleblowers are helping to fight healthcare fraud

Earlier this month, the Department of Justice announced it had resolved a $237 million judgment against Toumey Healthcare System in South Carolina for violations of the Stark Law. In this particular case, the hospital was alleged to have entered into contracts with 19 specialists that required them to refer their outpatient procedures to the hospital […]

ICD-10: How is your practice handling the transition?

It’s been a few weeks since the launch of ICD-10 and there have been a number of stories written about some of the challenges that healthcare providers are facing and how the new billing codes are having an impact on their practices and patient care. Although still early in its implementation, it appears those who […]

OMHA to expand Medicare appeals process

Faced with skyrocketing processing times, the Office of Medicare Hearings and Appeals (OMHA) says it plans to expand its Settlement Conference Facilitation pilot project in an effort to clear through the ever-growing backlog of claims appeals. The pilot project, which began in June 2014, is an alternative dispute resolution process. It was created to bring […]

Struggling with ICD-10 implementation? Our firm can help

While many healthcare providers have spent a great deal of time (and money) preparing for the Oct. 1 transition to ICD-10, as with any new system, problems are sure to arise. Remember what happened with the roll-out of Although there have been many implementation delays over the last few years, this no longer is […]

Healthcare executives on notice, DOJ cracking down on individuals for corporate misconduct

The federal government has taken a tough stance on healthcare fraud for many years. For the most part, companies caught up in the net have responded by paying huge fines and promising not to engage in fraudulent activities again. Despite the billions of dollars paid out, corporate fraud persists. Now, the feds are turning up […]

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