Jul 15th, 2016
Civil monetary penalties (CMPs) for violating the False Claims Act (FCA) are increasing substantially under an interim final rule that the Department of Justice (DOJ) published June 30 (81 Fed. Reg. 42491). The Federal Civil Penalties Inflation Adjustment Improvement Act of 2015, which was enacted as part of the Bipartisan Budget Act of 2015, mandated ...
Jul 1st, 2016
A final rule the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register on June 27 requires entities performing clinical diagnostic laboratory tests to report private payer rates for lab tests. CMS will use this data to calculate Medicare rates for lab tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning ...
In Billing
Feb 16th, 2016
A final rule, issued by the Centers for Medicare & Medicaid Services (CMS) on Feb. 12, clarifies reporting and repayment obligations for providers and suppliers who receive a Medicare overpayment. The final rule explains, “a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the ...
Mar 16th, 2015
The Office of Inspector General (OIG) announced March 16 that drug maker Sandoz Inc. will pay $12.64 million to settle allegations that it misrepresented drug pricing data between January 2010 and March 2012 to the Centers for Medicare & Medicaid Services (CMS). This is the largest settlement the OIG has ever agreed to under its drug ...
Understand two proposed rules and what they could mean for you. By Robert A. Pelaia, Esq., CPC, CPCO, and Drew Krieger, MBA The Office of Inspector General (OIG) released two proposed rules in May 2014 that would expand its authority to exclude individuals and entities from federal healthcare programs, and to impose civil monetary penalties (CMPs) ...