In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...
Jul 6th, 2017
Charlotte-Mecklenburg Hospital Authority is paying the federal government $6.5 million to resolve allegations the company violated the False Claims Act, up-coding claims for urine drug tests. The group, owned by Carolina HealthCare System, submitted high complexity evaluation and management (E/M) codes for urine drug tests, which Medicare considers moderate complexity. The government alleged that t...
Keep calm, know your responsibilities and risks, have a plan, and carry on. If your physician office receives a request for records from a health plan’s special investigations unit (SIU), your best defense is knowing the options, responsibilities, and duties attached to the request. Understand the SIU and FWA The SIU is part of the ...
In CMS
Feb 28th, 2017
New compliance program guidance has been issued by the Fraud Section of the Department of Justice (DOJ), according to an article published in the AHLA Weekly. Although the “Evaluation of Corporate Compliance Programs” (Guidance) is not specific to the healthcare industry, it does provide a practical set of benchmarks against which the audit & compliance committee, in ...
Time to give your physician office’s compliance plan an annual preventive exam. The Office of Inspector General (OIG) publishes annually a Work Plan describing new, ongoing, and revised areas within the U.S. Department of Health and Human Services (HHS) it will investigate throughout the year for potential fraud, waste, and abuse. It’s wise for providers ...