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HHS Takes Another Shot at Reducing Medicare Appeals Backlog

In an effort to clear the ever-growing Medicare appeals backlog, the U.S. Department of Health & Human Services has announced the launch of two new settlement options for providers and suppliers: a low-volume appeals (LVA) settlement and an expanded Settlement Conference Facilitation (SCF) process. LVA will be limited to appellants with a low volume of […]

HHS Offers New HIPAA Guidance in Light of Opioid Crisis

Shortly after President Donald Trump declared a nationwide public health emergency to combat the opioid crisis, the HHS Office for Civil Rights released new guidance on when and how healthcare providers can share a patient’s health information when that patient may be in crisis and incapacitated, such as during an opioid overdose. HIPAA regulations already […]

Feds Continue to Root Out Hospice Fraud

Last week, the U.S. Department of Justice announced that Chemed Corp., the parent company of VITAS Healthcare Corp., agreed to pay $75 million to resolve a government lawsuit alleging that the hospice provider violated the False Claims Act (FCA) by submitting false claims for services to Medicare. The settlement resolves allegations that between 2002 and […]

October a Big Month for Anti-Kickback Cases Involving Compounding Pharmacies

Physicians, recruiters and pharmacy owners continue to be the target of ongoing investigations into fraudulent claims involving compounded medications. A recent spate of arrests, guilty pleas and convictions serve to highlight the government’s increased level of scrutiny over the industry, mostly as it relates to improper relationships between pharmacies and physicians under the Anti-Kickback Statute. […]

Failure to Repay Can Result in FCA Case

There’s nothing wrong with holding on to money for as long as you can before giving it back, is there? Well, if you’re a medical practice and you delay repaying overpayments owed to the government, then it can get you in some hot water. That’s what happened to First Coast Cardiovascular Institute, P.A., a Jacksonville, […]

VA Proposal Would Expand Access to Care Via Telemedicine

Challenged by limited healthcare resources, the U.S. Department of Veterans Affairs has issued a proposal that would allow VA healthcare providers to serve patients across state lines via telehealth, regardless of where they are licensed to practice. For fiscal year 2016, VA healthcare providers had 2.17 million telehealth episodes serving more than 700,00 veterans, 45 […]

GAO: CMS Fraud Prevention Working

The days of “pay and chase” in the world of healthcare fraud are waning thanks to fraud prevention methods that the Centers for Medicare and Medicaid Services have put into place. A newly released report from the Government Accountability Office (GAO) finds that Fraud Prevention System (FPS), which analyzes fee-for-service claims to identify healthcare providers […]

Government Cracking Down on Genetic Testing Labs

As the use of genetic testing has grown in popularity, so too have the number of investigations into allegations that these labs may be paying kickbacks to physicians for ordering unnecessary tests. Most recently, two testing labs, Proove Biosciences in Irvine, Calif. and Dallas-based Next Health LLC, have been under investigation for doing just that. […]

CMS Issues Guidance on When a Hospital is a Hospital

Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now […]

Joint Commission Issues Alert on Hand-off Communication

“What we have here is a failure to communicate” is a line from the 1967 film Cool Hand Luke. It’s also a problem in the world of healthcare when one provider hands over a patient’s care to another for continued care and treatment. Earlier this month, the Joint Commission issued a new Sentinel Event Alert […]