Catherine Short speaks with Stephen Bittinger, Health Care Reimbursement Partner at K&L Gates, about the topic of “The Biggest Recent Health Care Scams & How to Avoid Being a Target.” We will be learning the mechanics of some of the largest recent health care fraud scams, how many providers became victims of these scams, and how to avoid these types of risks in the future. We will study the mechanics of health care fraud scams and the impact on providers caught in them, discover how to identify health care fraud scams and discuss resources for providers to educate themselves, and learn from other providers' mistakes on how to avoid health care fraud scams and decrease risk to revenue cycle.
The beginning of the New Year is a popular time for new initiatives. Many healthcare organizations are looking for ways to improve quality and reduce risk. A compliance program is an effective way to detect, deter and prevent wrongdoing in the healthcare setting and an ongoing system assures conformity with governing laws and regulations. An
Having a compliance program in place is a start but having an effective compliance program is the goal. Proactively assessing the effectiveness of one’s own compliance program is better than the Department of Justice making a determination of the adequacy as a result of an investigation for alleged misconduct. To set benchmarks for an effective
Health care fraud recoveries for fiscal years 2009- 2014 exceeded previous records with five straight years of more than $2 billion in annual recovery from cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid. Most healthcare providers are aware of significant civil liability due to recent enforcement. However,
Care Plan Oversight describes the physician or other healthcare professional’s supervision of patients in hospice, nursing facilities or those receiving care through home health agencies. CPO reimbursement covers initial certification, any re-certifications and care plan supervision. However, only physicians can bill for initial certification and re-certification and only one physician can bill per month. The
The whistleblower provisions of the False Claims Act have lead to several newsworthy cases in recent years. Just a few days ago, the Justice Department announced that KMART Corporation (Kmart) will pay $1.4 Million to resolve False Claims Act allegations for knowingly providing coupons to Medicare beneficiaries to waive or reduce co-pays for purchasing more