Blog

Compounding pharmacies in the eye of investigative storm

In the last year or so there have been a number of stories in the media about investigations into wrongdoing by compounding pharmacies, marketing companies and physicians. At last count there were nearly 100 federal investigations underway for what the feds believe are questionable financial relationships involving these three entities. In some instances, physicians are […]

Ready or not here ICD-10 comes

With less than three months until the implementation of the long-awaited ICD-10, it appears many providers are still unprepared – particularly in the areas of testing and assessing the impact it will have on revenue. A new report published by AHIMA and the eHealth Initiative finds that while half of the respondents had completed test […]

CMS’ fraud crackdown relies on high-tech analytics

The government’s crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments. Aptly named the “Fraud Prevention System,” the program has identified or prevented $820 million […]

CMS to cut providers a break when it comes to ICD-10 deadline

With the implementation of ICD-10 just around the corner (Oct. 1) comes word from the Centers for Medicare & Medicaid Services that it will not deny claims made under the Part B physician fee schedule if there are coding errors. The guidance notice, which was issued with the blessing of the American Medical Association, is […]

Federal prosecutors increasingly target individual healthcare execs in anti-fraud efforts

Last month’s sentencing of the former president and CEO of OtisMed Corporation to two years in prison should serve as yet another example that federal prosecutors are not holding back when it comes to holding corporate executives accountable. Charlie Chi was sentenced for intentionally distributing a medical device used in knee replacement surgery despite the […]

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 […]

CMS 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 […]

Latest 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 […]

OIG 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 […]

OIG 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 […]

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