Posts Tagged ‘Medicare audit’
Medicare Audit Finds Up To $888M in Improper Payments for Genetic Tests
Inadequate oversight by the Centers for Medicare & Medicaid Services (CMS) of payments for the highest paid genetic test risked up to $888 million in improper payments, according to a recent audit by the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG). OIG reviewed Medicare Part B claims for more…
Read MoreOIG Report: CMS Fails to Collect Millions in Overpayments
The Centers for Medicare and Medicaid (CMS) failed to collect a large portion of Medicare overpayments identified over a two-year period between 2014 and 2016, according to an audit conducted by the U.S. Department of Health and Human Services Office of Inspector General. According to the watchdog agency, of $498 million in Medicare overpayments identified…
Read MoreAudits and Oversight Top OIG’s Workplan List for January
The January update to the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Workplan is out and there are several items that should be of interest to our clients. The Workplan sets forth various projects that either are underway or will be addressed during the fiscal year and beyond…
Read MoreOIG to Recover $4B in 2020 Resulting From Investigative Efforts
The U.S. Department of Health and Human Services Office of Inspector General recently reported that it expects to recover more than $4 billion in misspent Medicare, Medicaid and other HHS dollars as a result of its investigative efforts. While that is a lot of money, it is considerably less than the nearly $5.9 billion the…
Read MoreMedicare Audit Targets HHA Overpayments
Gem City Home Care, LLC became the most recent HHA to be ordered to pay back millions in overpayments following an audit by the Centers for Medicare & Medicaid Services. According to CMS, the Ohio-based agency failed to comply with billing requirements for 25 of 100 home health claims in fiscal years 2016 and 2017.…
Read MoreCMS: Audits to Return in August
After a five-month reprieve, the Centers for Medicare & Medicaid Services (CMS) says that as of Aug. 3, 2020 it will resume most Medicare Fee-For-Service (FFS) medical reviews that it suspended in March because of the COVID-19 pandemic. This includes pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate…
Read MoreYou Received an Audit Letter, Now What?
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…
Read MoreCMS Revamps Medicare Audit Strategy
Good news for some healthcare providers and not so good news for others. The Centers for Medicare & Medicaid has announced changes to its Medicare audit strategy in an effort to root out fraud and abuse. The new process is based on a pilot program that CMS introduced in 2014 in which the agency combined…
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