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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 […]

OIG Takes Notice as Compound Drug Use Skyrockets

The cost of compounded topical drugs to the country’s Medicare program has skyrocketed over the past several years, and that’s gotten the attention of a government watchdog agency. In a recently released report, The U.S. Department of Health and Human Services Office of Inspector General (OIG) found that Medicare Part D spending for these drugs […]

CMS to Ease HHA, Ambulance Enrollment Restrictions

The Centers for Medicare & Medicaid Services (CMS) will ease restrictions it imposed on the enrollment of new home health and non-emergency ambulance providers in six states. In a notice that appeared in the Aug. 20 issue of the Federal Register, CMS announced that providers will be able to apply for a waiver to the […]

Hospital Offering Patient Discounts not Entitled to Full Reimbursement by Insurer

Cigna Healthcare emerged victorious from a lawsuit filed by a Houston hospital that had accused it of underpaying claims to the tune of at least $50 million. In an August 7 ruling, U.S. District Court Judge Keith Ellison of the Southern District of Texas found that the insurer did not abuse its discretion when it […]

CMS Proposes Payment Changes for Medicare HHAs for 2019

The Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposed rule that will impact payment and policy for home health agencies and home infusion therapy suppliers. The proposed rule is an update to the Medicare home health prospective payment system rates for calendar year 2019, as well as a broader case-mix […]

Medical Device Maker Settles False Claims Allegations, Agrees to Pay $12.5M

A New York-based medical device manufacturer has agreed to pay $12.5 million to settle allegations it caused healthcare providers to submit false claims to federal healthcare programs relating to the use of two of its medical devices. AngioDynamics Inc. was accused of causing false claims to be submitted to Medicare, Medicaid, TRICARE, and other federal […]

CMS Proposes Sweeping Changes to Restore Doctor-Patient Relationship

Talk to any healthcare provider and one of the things you likely will hear is that they spend too much time on paperwork and not enough time with patients. The Centers for Medicare & Medicaid Services (CMS) says it wants to change that. Earlier this month, the agency that administers the Medicare program proposed what […]

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