Blog

OIG Alert: Beware of Genetic Testing Scam

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) recently sent out an alert about a fraud scheme involving genetic testing. The government watchdog agency said Medicare beneficiaries are being offered the chance to get tested for certain genetic conditions through the use of a simple cheek swab, but they […]

OIG Cracks Down on Home Health Questionable Billing Practices

A few years back, as part of its Work Plan, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) announced it was seeking to identify home health agencies, supervising physicians, and geographic areas whose Medicare claims had characteristics similar to those observed by the agency in cases of home health […]

Incident-to Billing Investigation Ends in $118,000 Fine

A physician in Texarkana, Texas recently agreed to pay $118,000 to settle allegations he engaged in improper billing practices for his Medicare patients at three of his clinics. According to the allegations, Dr. Donald S. Douglas’ advanced practice nurses (APNs) were hired to assist him with seeing patients in his clinics. By law, if the […]

Florida’s Behavior Analysts Make Some Strides

Last month, we wrote about Florida’s Agency for Health Care Administration (AHCA) decision to postpone planned cuts to Medicaid reimbursement rates for behavioral health therapists. But at that time, AHCA did not specify for how long the postponement would last. Now, we learn from the Florida Association for Behavior Analysis that the Florida Legislature is […]

DoD Wants to Impose CMPs on Those Who Defraud TRICARE

Plagued by fraud and abuse targeting its TRICARE program, the U.S. Department of Defense, on May 1, issued a proposed rule that would allow it to impose civil monetary penalties (CMPs) against providers and suppliers who commit fraud and abuse against the TRICARE program. The new rule would create the “Military Health Care Fraud and […]

HHS Makes Changes to HIPAA Civil Monetary Penalty Caps

The U.S. Department of Health and Human Services (HHS) has issued a notification that it is changing the way it applies the assessment of Civil Money Penalties (CMPs) against those who violate the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (“HITECH”) […]

CMS Issues Proposed Rules for Rehab and Skilled Nursing Facilities

On April 17, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would update Medicare payment policies for Medicare Inpatient Rehabilitation Facilities (IRF). Two days later, on April 19, CMS issued another proposed rule, this one updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs). Let’s start […]

April OIG Work Plan Focuses on Oversight of State, Federal Funding

Each month, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases updates to its Work Plan, which outline the various projects it intends to focus on in the coming months. The April Work Plan addressed a number of items that should be of interest to a variety of […]

AHCA Postpones BA Therapy Cuts

Florida’s Agency for Health Care Administration (AHCA) has decided to postpone planned cuts to Medicaid reimbursement rates for behavioral health therapists, many of whom work with children on the autism spectrum. In March, AHCA proposed payment reductions for a variety of services as outlined below: Payments for Behavior Analysis Assessment to decrease from $385.19 to […]

Clinical Lab Industry Ripe for Fraud and Abuse

A former account rep for a toxicology testing company in Texas is the latest to be sentenced for his role in a Medicare fraud scheme that has become more common in recent years. Last month, Ivar Cantu was handed a 56-month sentence, to be followed by three years of supervised release, after pleading guilty to […]

Material presented on the Health Law Offices of Anthony C. Vitale's website is intended for information purposes only.

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