Feds target healthcare fraud by looking for outliers

Last week, the U.S. Department of Justice announced the largest healthcare fraud takedown in its history. Approximately 300 defendants in 36 federal districts, including South Florida, were charged with engaging in fraudulent billings to the tune of more than $900 million. Charges included: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering […]

Florida Home Health Agencies Targeted by CMS for Pre-claim Review

Florida is one of five states that the Centers for Medicare & Medicaid Services (CMS) is targeting for a three-year Medicare pre-claim review demonstration for home healthcare services. However, just how this program will work has raised questions in the home healthcare community. CMS says the steps it is taking are designed to “provide timely […]

CMS issues new condition code for home health claims

The Centers for Medicare and Medicaid Services (CMS) has added a new condition code that will allow home health claims for subsequent episodes to process, even if skilled nursing services are not required. The change takes effect July. 1 Currently, any home health claim that is submitted without skilled nursing visits are automatically returned to […]

CMS extends moratoria for home health agencies, ambulance suppliers

The Centers for Medicare and Medicaid Services (CMS) is continuing its crackdown on fraud and abuse and South Florida providers are, not surprisingly, on its hit list. CMS announced on Jan. 30, new temporary moratoria on the enrollment of home health agencies in four cities including Fort Lauderdale. It also is extending, for another six […]