Overview of a Corporate Integrity Agreement (CIA)
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…
Are You Prepared for the HIPAA Phase 2 Audits?
After reviewing the HIPAA Privacy case investigations from 2009-2011, the Office of the Inspector General sent a strong message to the Office of Civil Rights in regard to the administration…
Stark vs. Anti-Kickback: A Quick Comparison
The Federal Anti-Kickback Statute and the Stark Law are often confused because both laws deal with remuneration related to improper referrals. Large groups and multi-specialty practices must make an effort…
Billing Care Plan Oversight Risks
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,…
Are You Aware of the Whistleblower Provisions of the False Claim Act ?
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)…
Complying with Stark Law: Can you bill Medicare when treating your family members?
The treatment of family members falls under General Exclusions from Coverage under Medicare. No payment will be made for items or services for a family member when the charge is…
LEIE: Do You Know About the List of Excluded Individuals and Entities?
The Exclusions Statute is one of five major federal fraud and abuse laws. Exclusion is an administrative remedy that is in the form of a penalty imposed on a provider.…
How would your staff react to an auditor or investigator?
Audits and investigations are stressful events either with or without prior notice. Medical staff should be prepared for an unannounced visit. First Healthcare Compliance provides a sample policy that assists…
Avoiding Overutilization vs. Patient Satisfaction: What’s a provider to do?
An increasingly important issue for many providers is the dilemma of providing care that is satisfactory to the patient while avoiding overutilization and its effect on reimbursement. Unfortunately, the patient’s…
Are you trying to prevent medical identity theft?
Medical identity theft continues to be major problem in the US with approximately 2.32 million adults or close family members falling victim in 2014. According to the Fifth Annual Study…
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