Although Anti-kickback violation remains a felony, safe harbors are proposed to expand exception allowance. By Robert A. Pelaia, Esq., CPC, CPCO, and Drew Krieger, MBA Medicare and Medicaid fraud each pose a huge expense for taxpayers, amounting to billions of dollars, per year. The Anti-kickback Statute (AKS) aims to reduce fraud by deterring individuals or ...
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) ...
In Billing
Oct 1st, 2013
Before you self-disclose, be sure to undergo a detailed internal investigation. On April 17, 2013 the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) issued an updated Provider Self-Disclosure Protocol, revising its guidance on how healthcare providers, suppliers, and other individuals or entities can voluntarily identify, report, and resolve instances ...
Sep 1st, 2013
Coding Compass Because so many factors weigh into the answer, it depends. By Robert A. Pelaia, Esq., CPC, CPCO Every year at AAPC’s national conference, several members of AAPC’s Legal Advisory Board present an open forum session to respond to a wide variety of questions from attendees. For the past few years, without fail, audience ...
Nov 1st, 2011
Question Here is an excerpt from the Medicare Program Integrity Manual, Pub. 100-08, chapter 3, section 3.3.2.5, which addresses Late Entries in the Medical Documentation:“This section applies MACs, CERT, Recovery Auditors, and ZPICs, as indicated.A provider may discover that certain documents were misfiled or needed to be filed in the medical documentation during the process ...