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, ...
Providers Should Exercise Caution When Handling Overpayments — More than Likely, You Can’t Keep It, Even if the Payor Doesn’t Want it Back
(July 15, 2010): Since the May 2009 passage of the Fraud Enforcement and Recovery Act (FERA) and subsequent enactment of the PPACA, we’ve heard a lot about how the government looks at Medicare overpayments and how providers should handle them. Two major misconceptions seem to underlie the public response to provisions clarifying that failure to timely refund Medicare overpayments can result in False Claims Act (FCA) liability. I. Historical Overview of the “Overpayment” Issue Prior to the clarification and statutory reinforcement of the “overpayment” issue provided by PPACA, a number of providers have mistakenly believed that in the absence of ...
HHS / CMS Issues Final “Meaningful Use” Objectives for Electronic Health Records (EHRs). Providers Should Exercise Extreme Caution Before Converting to an EHR System.
(July 14, 2010): Yesterday, the Department of Health and Human Services (HHS) issued its final regulations concerning what it means for eligible Medicare and Medicaid providers to be “meaningful users” of certified electronic health record (EHRs) technology in 2011 and 2012. We are cautiously optimistic that HHS’ approach will allow small providers the flexibility they need to participate in the program if they choose but, as detailed below, are not convinced that CMS contractors are ready for the technology. The rules support the Health Information Technology for Economic and Clinical Health Aid Act (HITECH), which authorized incentive payments through Medicare and ...
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 to health care fraud matters, 21 counts of mail fraud, 16 counts of wire fraud, 4 counts of unlawful distribution of a controlled substances and 16 counts of money laundering. The indictment alleges that the physician “caused to be submitted claims ...
PPACA Creates a Minefield for Medicare Providers Who Fail to Promptly Return a Medicare Overpayment
(July 9, 2010): Does the failure to promptly return a Medicare overpayment warrant liability under the False Claims Act (FCA)? Congress thinks so. The Patient Protection and Affordable Care Act (PPACA) creates new obligations under the FCA whereby a Medicare provider who fails to timely report and refund an overpayment may be subject to substantial penalties and damages. Section 6402 of the PPACA requires Medicare providers, including physicians and partial hospitalization providers, among others, to a) return and report any overpayment, and b) explain, in writing, the reason for the overpayment. This law creates a minefield for physicians and other Medicare providers. First, providers have only ...
Identity Theft “Red Flags” Rule Treating Doctors Like Banks Is Delayed Once Again
(July 5, 2010): The Federal Trade Commission (FTC) has agreed to once again delay enforcement of its illogical and onerous “Red Flags” rule with respect to physicians. The “Red Flags” rule arises under the Fair and Accurate Credit Transactions Act of 2003 and requires “financial institutions” and “other creditors” to develop written plans to detect identify theft in their day-to-day operations. Under the FTC’s interpretation of the rule, physicians who permit patients to pay after they have rendered medical service are transformed into “creditors.” Extension of the rule to physicians has been delayed several times as the extent of the burden on ...
Look at RACs — Part III: What Should Physicians and other Medicare Providers Know about Appeals and Recoupment?
(July 2, 2010): CMS’ Recovery Audit Contractor (RAC) program is now permanent and nationwide. As we discussed in Part I of this series, while small providers were largely ignored during the demonstration program, physicians, home health, hospice, and durable medical equipment (DME) suppliers should be on the lookout for increased attention. In Part II, we discussed some ways providers can prepare for and respond to an audit request. In this Part III, we will discuss a provider’s appeal options in the event that a RAC identifies an alleged overpayment as a result of its audit. It is important to remember that ...
What is Causing the Spike in Partial Hospitalization Overpayment Actions?
(June 30, 2010): Are Partial Hospitalization Programs (PHPs) and Community Mental Health Centers (CMHCs) being unfairly targeted in the Administration’s push to identify and recover allegedly improper Medicare payments? In May 2010, the Office of the Inspector General of the HHS (HHS-OIG) published an assessment of the Program Safeguard Contractors (PSCs) overpayment collections that identified only 2 overpayment referrals for partial hospitalization claims in 2007. These referrals accounted for only $403,935 of approximately $835 million in overpayment referrals -- less than 0.1% of the total. Yet, we are aware of far more overpayment cases involving CMHCs (many of which are in the ...
Health Care Issues -- General
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...
HHS / CMS Issues Final “Meaningful Use” Objectives for Electronic Health Records (EHRs). Providers Should Exercise Extreme Caution Before Converting to an EHR System.(July 14, 2010): Yesterday, the Department of Health and Human Services (HHS) issued...
PPACA Creates a Minefield for Medicare Providers Who Fail to Promptly Return a Medicare Overpayment(July 9, 2010): Does the failure to promptly return a Medicare overpayment warrant...
Read More Posts From This CategoryMedicare Audits
Providers Should Exercise Caution When Handling Overpayments — More than Likely, You Can’t Keep It, Even if the Payor Doesn’t Want it Back(July 15, 2010): Since the May 2009 passage of the Fraud Enforcement and Recovery...
Look at RACs — Part III: What Should Physicians and other Medicare Providers Know about Appeals and Recoupment?(July 2, 2010): CMS’ Recovery Audit Contractor (RAC) program is now permanent...
What is Causing the Spike in Partial Hospitalization Overpayment Actions?(June 30, 2010): Are Partial Hospitalization Programs (PHPs) and Community Mental...
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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