Audits of Texas and Oklahoma Home Health Agencies are on the Rise — Is Your Compliance Plan Current and Effective?
(August 16, 2011): I. Overview: Over last few years, the government’s reliance on private contractors to both identify overpayments and potential instances of fraud has greatly increased. Health Integrity is the Zone Program Integrity Contractor (ZPIC) awarded the contract for Zone 4 (Texas, Oklahoma, Colorado and New Mexico) by the Centers for Medicare and Medicaid Services (CMS). II. Home Health Agencies are Currently Being Scrutinized: As home health agencies in Texas and Oklahoma can readily attest, Health Integrity is carefully examining home health claims billed to Medicare. Home health agencies may be subjected to the following actions by Health Integrity: Unannounced site visits – leading ...
HHS-OIG has Found that More than Half of All Power Wheelchairs Claims Paid by Medicare are Improper — Suppliers Need an Effective Compliance Plan Now More than Ever.
(July 16, 2011): Despite continuing efforts by many Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) companies to address and remedy long-standing compliance risks, the Department of Health and Human Services, Office of Inspector General (HHS-OIG), reported this month that more than one-half of the billings for power wheelchairs by Durable Medical Equipment (DME) suppliers were improper during the period audited. I. Scope of the Problem: As HHS-OIG’s July 2011 report details, approximately 61% of the power wheelchairs billed to Medicare during the period reviewed were either medically unnecessary or lacked sufficient documentation for HHS-OIG to determine medical necessity. Collectively, these ...
Texas Physicians are Starting to Level the Playing Field in Their Dealings with the Texas Medical Board.
(June 21, 2011): Last week, Texas Governor Rick Perry signed legislation aimed at bringing modest medical reform to the rules governing investigations of physicians by the Texas Medical Board ("TMB" and / or the "Board"). The Board is the state’s regulatory body that licenses and disciplines physicians and other health care professionals. House Bill 680 (HB 680), which takes effect on September 1, 2011, is seen as a hard-fought victory by Texas physicians. To their credit, the Association of American Physicians and Surgeons (AAPS), a professional association of physicians in all types of practices and specialties, has reportedly been one ...
When it Rains, it Pours . . . DME Suppliers are Facing Even More Regulations — An Effective Compliance Program is Important Now, More than Ever Before.
(April 6, 2011): I. Background: On September 15, 2010, the Inspector General of the Department of Health and Human Services (HHS-OIG), Daniel Levinson, testified before the House Committee on Energy and Commerce, Subcommittee on Health regarding waste, fraud, and abuse in the Medicare program, with a specific focus on durable medical equipment and supplies. Mr. Levinson noted that, over the last three decades, HHS-OIG has detected “significant levels” of fraud and abuse related to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). These concerns have resulted in steadily increasing oversight of DMEPOS suppliers by HHS-OIG and Medicare contractors. Perhaps most significantly, these ...
Under Health Care Reform Legislation, Stark’s Whole Hospital and Rural Provider Exceptions are Changing
(October 22, 2010): It’s not exactly breaking news to anyone in the hospital industry that the U.S. Congress and the regulators at the Center for Medicare and Medicaid Services seem bent on preventing or eliminating physician referrals to hospitals in which they invest. With the passage of health reform legislation in March of this year, Congress approved yet another round of sweeping measures designed to eliminate or prevent the growth of physician investment in hospitals to which they refer by drastically changing both the rural provider and whole hospital ownership exceptions to the Stark Law. Here are a few key points ...
Is More Medicare Fraud Legislation on the Way?
(September 15, 2010): Notably, on September 14th, members of the House Ways and Means Health Subcommittee introduced legislation cited as "Strengthening Medicare Anti-Fraud Measures Act of 2010" which would expand current permissive exclusion provisions to permit HHS-OIG to exclude owners, officers and managers of companies that are convicted of health care fraud. The proposed legislation appears to be quite broad and arguably could result in an officer being excluded from participation in Federal Health Benefits programs even if he was no longer working at the company when it convicted of the crime, as long as the officer was at the company when ...
HHS-OIG Alleges that 70% of the Medicare Claims Recently Audited for Home Blood-Glucose Test Strips and Lancets Were Improperly Paid by the MAC for Jurisdiction A
(September 6, 2010): HHS-OIG recently issued its audit findings examining Home Blood-Glucose Test Strips and Lancets paid by the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) responsible for claims in Jurisdiction A (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington DC). As the audit report reflects, 70 of the 100 sampled claims examined contained or more documentation deficiencies. Specific problems identified include: The quantity of blood-glucose strips and / or lancets utilized which exceeded utilization guidelines failed to properly document the reasons why additional supplies were needed. There was no documentation supporting ...
Additional Cities will have HEAT Teams in 2011
(August 27, 2010): Yesterday, Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” The first summit was recently conducted in Miami, Florida. This summit was held in Los Angeles, California. In addition to these agency heads, summit participants learned of current and additional planned initiatives from a number of Federal and State law enforcement officials. Describing the progress made in the last fiscal year, Attorney General Holder noted that: "In just the last fiscal year, we’ve won or negotiated more than $1.6 billion ...
States Are Taking Aim at Home Health Providers – Florida’s MFCU Will Expand Their Review and Investigation of Home Health Providers Billing Medicaid – Your State May be Next
(July 19, 2010): Home health care providers are in the crosshairs again. On July 15, HHS granted Florida a waiver of the anti-data mining provisions of federal Medicaid program regulations that will allow its Medicaid Fraud Control Unit (MFCU) to begin seeking out reasons to investigate home health and other providers for fraud. While Florida is the first and currently the only state to obtain a waiver of this type, if Florida’s pilot program “succeeds”, the other 49 MFCUs could soon be doing the same thing. MFCU “strike forces” are designed to investigate referred cases of fraud. They are prohibited by ...
Medicare Fraud Strike Force Operation Leads to Charges against 94 Defendants, including 4 in South Texas
(July 17, 2010): Yesterday, the Department of Justice (DOJ) announced charges against 94 physicians, medical assistants, and health care company owners and executives in connection with alleged false Medicare claims amounting to more than $251 million. 24 defendants from Miami account for approximately $103 million of that amount. Four defendants were charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for durable medical equipment (DME). Other arrests were made in Baton Rouge, Brooklyn, and Detroit. The offenses charged include conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, ...
Health Care Issues -- General
Texas Physicians are Starting to Level the Playing Field in Their Dealings with the Texas Medical Board.(June 21, 2011): Last week, Texas Governor Rick Perry signed legislation aimed...
Under Health Care Reform Legislation, Stark’s Whole Hospital and Rural Provider Exceptions are Changing(October 22, 2010): It’s not exactly breaking news to anyone in the hospital...
Is More Medicare Fraud Legislation on the Way?(September 15, 2010): Notably, on September 14th, members of the House Ways and Means...
Read More Posts From This CategoryMedicare Audits
Audits of Texas and Oklahoma Home Health Agencies are on the Rise — Is Your Compliance Plan Current and Effective?(August 16, 2011): I. Overview: Over last few years, the government’s...
HHS-OIG has Found that More than Half of All Power Wheelchairs Claims Paid by Medicare are Improper — Suppliers Need an Effective Compliance Plan Now More than Ever.(July 16, 2011): Despite continuing efforts by many Durable Medical Equipment,...
When it Rains, it Pours . . . DME Suppliers are Facing Even More Regulations — An Effective Compliance Program is Important Now, More than Ever Before.(April 6, 2011): I. Background: On September 15, 2010, the Inspector...
Read More Posts From This CategoryHEAT Enforcement
Additional Cities will have HEAT Teams in 2011(August 27, 2010): Yesterday, Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” The first summit was recently conducted in Miami, Florida. This summit was held in Los Angeles, California. In... [Read more of this review]
Medicare Fraud Strike Force Operation Leads to Charges against 94 Defendants, including 4 in South Texas(July 17, 2010): Yesterday, the Department of Justice (DOJ) announced charges against 94 physicians, medical assistants, and health care company owners and executives in connection with alleged false Medicare claims amounting to more than $251 million. 24 defendants from Miami account for approximately $103 million of that amount. Four defendants... [Read more of this review]
Texas Psychiatrist Indicted and Arrested(July 9, 2010): On June 14, 2010 the U.S. Attorney’s Office for the Western District of Texas announced that a Federal Grand Jury had returned a 99-count indictment against a pain management physician who operated clinics in San Antonio and El Paso. The physician was charged with 21 counts of health care fraud, 20 counts of false statements relating... [Read more of this review]
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