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Latest Medicare fraud sting should serve as wake-up call

This week’s takedown by the Medicare Fraud Strike Force of 243 people nationwide should serve as a wake-up call to everyone in the medical profession. The arrests, according to federal officials, were due in large part to the government’s increasing use of sophisticated computer programs designed to detect patterns of potential fraud – which in […]

OIG cracking down on medical director compensation

If you are thinking of taking on medical director responsibilities, or you are a medical director, there are some things you need to know to ensure that you do not run afoul of kickback laws. On June 9, the OIG issued a fraud alert noting that physicians who enter into compensation arrangements, such as medical […]

OIG adds 21 new investigative focus areas

The Office of Inspector General at the U.S. Department of Health and Human Services recently released the midyear update  of its annual work plan, which not only outlined its accomplishments between October 2014 and May 2015 but also added 21 new focus areas for next year. The OIG noted that it will continue to look […]

CMS unveils proposed rules for Medicaid managed care plans

On May 26, The Centers for Medicare & Medicaid Services (CMS) released its long-awaited proposed rule, updating its Medicaid managed care organization regulations. The proposal is designed to “better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing […]

OIG cracks down on place-of-service overpayments

Is your practice using proper place-of-service codes? If not, you’re not alone. According to a new report from the HHS Office of Inspector General, Medicare contractors may have overpaid physicians to the tune of $33.4 million for incorrectly coded services provided between January 2010 and September 2012. Why? It appears that the services were performed […]

OIG guidance for healthcare governing boards focuses on responsibility

You have probably heard the saying “The buck stops here.” Popularized by President Harry S. Truman, the phrase still holds true today for many in positions of authority. When it comes to compliance oversight in the healthcare industry, the federal government is turning its focus more than ever on boards of directors and trustees to […]

ICD-10 implementation clock ticking

With the deadline for implementation of ICD-10 just five months away, a lot is being written about whether medical practices are prepared. As late as April 30, Rep. Ted Poe of Texas introduced a bill that would prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code […]

Home healthcare agencies, aides top fraud list

Home healthcare agencies and home healthcare aides topped the list of providers with the largest number of healthcare fraud convictions in 2014, according to a report released last month by the HHS Office of the Inspector General. Of the more than $1.9 billion recovered in total civil judgments and settlements, the federal government recovered $186 […]

Updating HIPAA compliance in an age of data breaches

Recent data breaches at some of the country’s major healthcare organizations have prompted the Office of the National Coordinator for Health IT (ONC) to update its 2011 version of its Guide to Privacy and Security of Electronic Health Information. The new guide, says the ONC, is specifically geared toward those providers who are “eligible professionals” […]

What happens if you become the target of a healthcare fraud investigation?

No healthcare provider wants to become the target of a healthcare fraud investigation. But, as we have seen, it happens more often than we would like to think. Not only does a healthcare fraud investigation come with the potential for criminal penalties, but the state also can impose harsh consequences resulting in the loss of […]

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