OIG WORKPLAN 2016
The Office of the Inspector General (OIG) is responsible for protecting the integrity of the programs in Health and Human Services against fraud, waste and abuse as well as recommending…
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…
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…
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…
Are you a Meaningful User of the Future?
Since the Electronic Health Records (EHR) incentive program known as Meaningful Use began in 2011, the healthcare community has felt its impact and attempted to meet the increasing obligations. A…
$22 M of Potential Fraud, Waste and Abuse Discovered in 2012 Medicare Ophthalmology Claims
In 2012, approximately 49 million Medicare claims were related to screening, diagnosis or treatment of cataracts, wet acute macular degeneration and/or glaucoma. Medicare paid approximately $3.5 billion for these particular…
CMS Just Announced New Provider Enrollment Provisions
As of December 3, 2014, new safeguards have been added to the CMS provider enrollment policies. CMS continues to focus on prevention of Medicare fraud, waste and abuse as part…
Are You Billing for Home Care Visits?
Physician home visits are under scrutiny by CMS for any possible fraud. In 2012, Medicare paid home care service providers about $236 million. As the population of Medicare age recipients…
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