In Audit
Jul 13th, 2017
Think your healthcare covered entity doesn’t need to establish and maintain Business Associate Agreements (BAA) with companies who can access your patients’ protected health information (PHI)? Think again. Cases in Point March 2016 — North Memorial Health Care agreed to pay the U.S. Department of Health and Human Services (HHS) $1,550,000 to settle charges that it potentially ...
In Audit
Jul 10th, 2017
A Detroit-area medical biller was recently sentenced to 50 months in prison for helping with a $7.3 million Medicare and Medicaid fraud scheme where services were billed but not rendered. Dawn Bentley, 56, of Oakland County, Michigan, was also ordered to pay $3,253,107 in restitution with her co-defendants for one count of conspiracy to commit ...
In Audit
Apr 7th, 2017
The main reason Medicare denies claims is because there is insufficient documentation in the medical record. For all surgical services, make sure the medical record has these four elements: Correct date of service Reason for procedure Signed operative report Physician signature and/or signature log or attestation for an illegible signature Showing medical necessity is only ...
In Audit
Jan 19th, 2017
In the 2017 Work Plan, the Office of Inspector General (OIG) is reviewing Medicare’s billing and reimbursement integrity for two diagnosis-related groups (DRGs): inpatient claims for kwashiorkor diagnosis and mechanical ventilation. Kwashiorkor is a severe protein malnutrition that usually “affects children living in tropical and subtropical parts of the world during periods of famine or ...
In Audit
Jan 10th, 2017
If you haven’t stumbled on the treasure trove of information in the Office of Inspector General’s (OIG) Media section of their website, it’s time you found it. OIG now keeps you informed on fraud, enforcement, and compliance via podcast. The podcasts are found on the OIG website with Mike Kane, Office of External Affairs, discussing the monthly ...