In Billing
Aug 19th, 2019
You may think you are doing your patients a favor when you write off their copays for your providers’ services. But you may hurt yourself badly in the process if you do. That’s because your practice’s generosity in waiving a patient’s financial responsibility may be violating the terms of your contract with a private payer, ...
In CMS
Jul 31st, 2019
Re-evaluate your kickback compliance to include EKRA and the Travel Act’s racketeering statute for bribery. If a relationship with physicians or other referral sources has been structured to carve out Medicare and Medicaid patients to avoid triggering Anti-kickback Statute and Stark Law requirements, it’s time to review its compliance. Define Kickback and Self-referral Laws Federal ...
Apr 1st, 2019
Although the scope of its enforcement is not yet determined, ensure your business relationships with laboratories do not violate EKRA. New Anti-kickback provisions in the Eliminating Kickbacks in Recovery Act of 2018 (EKRA) targets recovery homes, clinical treatment facilities, and laboratories that participate in illegal remuneration schemes. EKRA is Section 8122 of the Substance Use-Disorder ...
Nov 10th, 2017
Lately it seems that the Office of Inspector General’s (OIG) focus is on fraud and abuse of federal healthcare dollars via the False Claims Act; however, a case in Newark, N.J., has proven that the Anti-Kickback Statute also is being enforced in a big way. A Staten Island doctor, Ahmed El Soury, has been sentenced ...
Promote a compliant environment within your organization, before the whistle is blown. The most notable Medicare fraud cases in the last five years have been whistleblower cases in which someone with inside knowledge of a health system or physician practice (usually an employed physician or administrator) files suit against the employer under the federal False ...