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 […]

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 […]

Common Healthcare Fraud Schemes

Last month’s indictment of more than 600 people nationwide in what the feds dubbed “the largest healthcare fraud takedown in history,” should serve as a warning that the government is serious about cracking down on those who abuse the system. As we wrote about in June, of the 601 defendants charged, 165 were medical professionals […]

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, […]

The FCA and the Use of Statistical Sampling

The U.S. Department of Justice late last month agreed to a $275,000 settlement in a False Claims Act case against a South Carolina-based company that operates elder care facilities. What’s significant about this case is that two years earlier, the DOJ rejected a significantly higher – $2.5 million – settlement. In the initial case, United […]

Feds File False Claims Act Lawsuit Against UnitedHealth Group

Is it the government’s “murky policies,” as suggested by a UnitedHealth spokesman, or was it outright fraud that led to allegations the healthcare insurance giant engaged in fraud? That’s a question that will have to be answered following the U.S. Department of Justice’s recent decision to intervene and file a complaint against UnitedHealth Group (UHG). […]

Why You Need a HIPAA-Compliant Business Associate Agreement

The recent announcement by The Department of Health and Human Services’ Office for Civil Rights (OCR) that it agreed to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) with The Center for Children’s Digestive Health (CCDH) should serve as a lesson to other healthcare organizations about the need to obtain signed, […]

CMS Looks to Streamline Self-Disclosure Process

In an attempt to streamline the self-disclosure process, The Centers for Medicare and Medicaid Services (CMS) recently posted revisions to the Voluntary Self-Disclosure Protocol (SRDP), which allows providers of healthcare services and suppliers to self-disclose actual or potential violations of the federal physician self-referral law. Beginning June 1, providers of services and suppliers must use […]

CMS Easing DME MAC Requirements

The Centers for Medicare and Medicaid (CMS) is modifying requirements for DME Medicare Administrative Contractors (MACs) by allowing them to accept timely orders and medical documentation, regardless of whether the supplier received the documentation directly from the beneficiary’s eligible practitioner or from a transferring supplier, as long as they meet Medicare requirements. In a Change […]

When Ignorance is Not a Defense

A 79-year-old New Jersey physician who was charged in connection with a healthcare kickback scheme now faces sentencing in June after being convicted of accepting bribes in exchange for blood test referrals. As we previously wrote about, Dr. Bernard Greenspan, 79, was among more than 40 people, many of them physicians, who allegedly accepted payments […]

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