Archive for June 2015
Medicare Part D fraud fastest growing component of program
When the Department of Justice earlier this month announced the arrest of 243 people for Medicare fraud, it noted that 50 of the defendants were charged with crimes related to the Medicare prescription drug benefit program known as Part D. Prescription drug fraud has become the fastest-growing component of the Medicare program overall, and is…
Read MoreCMS releases final rule for Medicare Shared Savings Program ACOs
The Centers for Medicare & Medicaid (CMS) earlier this month released its much- anticipated Final Rule updating the Medicare Shared Savings Program. The whole concept behind the program, created by the Affordable Care Act (ACA), is to encourage participation among providers through the use of accountable care organizations (ACOs). ACOs are groups of providers that…
Read MoreLatest Medicare fraud sting should serve as wake-up call
This week’s takedown by the Medicare Fraud Strike Force of 243 people nationwide should serve as a wake-up call to everyone in the medical profession. The arrests, according to federal officials, were due in large part to the government’s increasing use of sophisticated computer programs designed to detect patterns of potential fraud – which in…
Read MoreOIG cracking down on medical director compensation
If you are thinking of taking on medical director responsibilities, or you are a medical director, there are some things you need to know to ensure that you do not run afoul of kickback laws. On June 9, the OIG issued a fraud alert noting that physicians who enter into compensation arrangements, such as medical…
Read MoreOIG adds 21 new investigative focus areas
The Office of Inspector General at the U.S. Department of Health and Human Services recently released the midyear update of its annual work plan, which not only outlined its accomplishments between October 2014 and May 2015 but also added 21 new focus areas for next year. The OIG noted that it will continue to look…
Read MoreCMS unveils proposed rules for Medicaid managed care plans
On May 26, The Centers for Medicare & Medicaid Services (CMS) released its long-awaited proposed rule, updating its Medicaid managed care organization regulations. The proposal is designed to “better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing…
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