In CMS
Jan 21st, 2019
Intermountain Healthcare wants the Supreme Court to weigh in on if the False Claims Act’s (FCA) provisions for whistleblowers violates the Constitution. This could affect compliance efforts across healthcare. Medical Judgment No FCA Sanctuary The issue arose last summer when the US Court of Appeals for the Tenth Circuit ruled that medical judgment can’t be ...
In Audit
May 30th, 2018
Retail giant accused of submitting claims for payment to Minnesota’s Medicaid program in violation of rules. Wal-Mart Stores, Inc. and Sam’s West, Inc. (d/b/a/ Sam’s Club) have agreed to pay a total of $825,000 to resolve False Claims violations, according to a May 29 press release from the U.S. Attorney’s Office for the District of Minnesota. ...
Regulatory reform has changed proof of litigation rules for guidance documents. Written by: Joette Derricks, MPA, FACMPE, CPC, CHC, CLSSGB On Jan. 25, the U.S. Department of Justice (DOJ) issued a memorandum (commonly referred to as the Brand memo) limiting the use of agency guidance documents in affirmative civil enforcement (ACE) cases. The memo stated, ...
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 ...
Healthcare business professionals have a duty to respect the claims process and our profession. The False Claims Act (FCA) imposes liability on anyone who knowingly presents, or causes to be presented, a false or fraudulent claim for payment, or who conspires to submit a false claim for payment. Because auditors, coders, and billers work on ...