Medicare Compliance & Reimbursement

The feds continue to see benefits from threatening providers with False Claims Act lawsuits, and that could mean more trouble for you down the road. Seven hospitals in six states have agreed to pay $6.3 million to settle allegations of overbilling for kyphoplasty procedures, according to a Department of Justice release. The procedures should have been performed outpatient instead of inpatient in many cases, the DOJ contends. The government has been using the FCA to strong-arm providers into fraud settlements when they were merely guilty of billing mistakes, the American Hospital Association recently protested (see "AHA to Federal Officials: Play Fair With the FCA" in Medicare Compliance & Reimbursement Vol. 36, No. 20). Non-contract durable medical equipment suppliers in competitive bidding areas who decided to continue furnishing bid items under the grandfathering exemption may have trouble securing their Medicare reimbursement. The problem: CMS has identified a claims system problem for [...]