Posts Tagged ‘overpayments’
OIG to CMS: Use Compliance Audits to Create Better Oversight
Last month, the Office of Inspector General (OIG) published a report based on a series of 12 audits conducted during calendar years 2016 through 2018. Its purpose was to determine whether the claims were billed appropriately, whether the Centers for Medicare & Medicaid Services’ (CMS) took action regarding recommendations in the audits and how CMS…
Read MoreOIG Revises Self-Disclosure Protocol
For the first time since 2013, The U.S. Department of Health & Human Services Office of Inspector General has issued updates to its Healthcare Fraud Self-Disclosure Protocol. Created in 1998, the protocol can be used to create a process to voluntarily identify, disclose and resolve instances of potential fraud involving federal healthcare programs. The OIG…
Read MoreApril OIG Work Plan Focuses on Oversight of State, Federal Funding
Each month, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases updates to its Work Plan, which outline the various projects it intends to focus on in the coming months. The April Work Plan addressed a number of items that should be of interest to a variety of…
Read MoreCourt Rules Against United’s Offsetting Policy
UnitedHealth Group’s policy of withholding payments to out-of-network physicians and doctors in order to recover previous overpayments – a practice known as cross-plan offsetting – is not permissible and may even violate The Employee Retirement Income Security Act (ERISA). That was the long-awaiting ruling from the Eighth Circuit Court of Appeals issued last week. The…
Read MoreWhat happens if you become the target of a healthcare fraud investigation?
No healthcare provider wants to become the target of a healthcare fraud investigation. But, as we have seen, it happens more often than we would like to think. Not only does a healthcare fraud investigation come with the potential for criminal penalties, but the state also can impose harsh consequences resulting in the loss of…
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