Medicare, Medicaid & Private Payor Updates

Provider Exclusion Screening / OIG Screening Practices are a Significant Risk

Medicare, Medicaid & Private Payor Updates /

(December 11, 2010): Has your practice conducted exclusion screening / OIG screening on all of you employees?Earlier this week, HHS-OIG announced that it had assessed significant civil monetary penalties against a health care provider that employed seven individuals who the provider “knew or should have known” had been excluded from participation in Federal health care […]

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HHS Publishes Proposed Rules on Medicaid RACs

Medicare, Medicaid & Private Payor Updates /

(November 30, 2010): The United States Department of Health and Human Services (“HHS”) recently published a Proposed Rule applying the Recovery Audit Contract (RACs) process to claims under the Medicaid program. As background, the RAC process has been a part of the Medicare program since 2005, first as a demonstration project from 2005 – 2008,

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CMS Authorizes Medicare Appeals by Fax and Secured Internet

Medicare, Medicaid & Private Payor Updates /

(November 21, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating that this change

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Under Health Care Reform Legislation, Stark Law Whole Hospital and Rural Provider Exceptions are Changing

Compliance, Regulatory Issues | Privacy | Other /

(October 22, 2010): It’s not exactly breaking news to anyone in the hospital industry that the U.S. Congress and the regulators at the Center for Medicare and Medicaid Services seem bent on preventing or eliminating physician referrals to hospitals in which they invest. With the passage of health reform legislation in March of this year,

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HEAT Strike Force Enforcement Takes an International Turn

HEAT Strike Force, Medicare, Medicaid & Private Payor Updates /

(October 17, 2010): Medicare’s HEAT Strike Force is actively tracking down wrongdoers. The FBI has announced the arrest of 73 defendants, a number of which are allegedly members of an international organized crime organization, as part of one of the largest criminal health care fraud cases ever brought. It is estimated that these individuals are

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The AHA Expresses its Concerns with Recent False Claims Act Kyphoplasty Cases

Medicare, Medicaid & Private Payor Updates /

(September 11, 2010): The American Hospital Association (AHA) has expressed its concern that the Department of Justice (DOJ) and its law enforcement partner, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) may be overreaching in its use of the False Claims Act in kyphoplasty cases. As set out in the AHA’s

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HHS-OIG Issues Report on Improper Claims for Nonemergency Transportation Services

Medicare, Medicaid & Private Payor Updates /

(September 6, 2010): The Department of Health and Human Services, Office of Inspector General (OIG) recently issued its report examining the costs of nonemergency transportation services reimbursed by Medicaid. Pursuant to 42 C.F.R. § 431.53, Texas and other States are required to ensure that Medicaid patients have transportation to medical facilities and providers to obtain

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HHS-ONC Names EHR Certification Bodies

Medicare, Medicaid & Private Payor Updates /

(September 1, 2010): Earlier this week, the Office of the National Coordinator for Health Information Technology (ONC), an organization within the Office of the Secretary of the Department of Health and Human Services (HHS), has named two entities as EHR Certification Bodies. They include: The Certification Commission for Health Information Technology (CCHIT), Chicago, Illinois, and

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DOJ is Using Medicare Billing Data to Target Health Care Providers

Medicare, Medicaid & Private Payor Updates /

(August 31, 2010): Last week, department heads of the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS), met in Los Angeles, CA and conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” Following-up on a similar conference held in Miami, DOJ Attorney General Eric

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Health Data Insights Begins Medical Necessity Reviews

Medicare, Medicaid & Private Payor Updates /

(August 30, 2010): Health Data Insights (HDI), the Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC) responsible for auditing health care providers in Region D, has announced it will immediately begin reviews on previously approved projects which involve the medical necessity of selected inpatient DRG payments. A complete list of the medical

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