In Billing
Dec 22nd, 2017
The Office of Inspector General (OIG) was busy in 2017. In the video, Eye on Oversight – 2017 Year in Review, released Dec. 20, the agency charged with protecting the integrity of U.S. Department of Health and Human Services (HHS) healthcare programs reflects on its accomplishments throughout the year. Summarizing the video, the OIG reports for ...
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 ...
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 ...