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$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 services. Review of the data using 4 National Coverage Requirements found $14 million in potentially inappropriate payments and according to 2 Local Coverage Requirements an […]
Have You Reviewed the OIG 2015 Workplan?
The 2015 Workplan of the Office of the Inspector General highlights important areas for providers including medical necessity of services billed, payment review, exclusions, and incentive payments. Determination of the medical necessity of services billed is a primary focus of the Workplan. As stated in the Social Security Act, Medicare will not pay for items […]
Do You Meet the Security Rule Requirements for a Covered Entity?
Covered entities should be aware of differences between the Privacy and Security Rule requirements regarding protected health information. One major distinction is that the HIPAA Security Rule only applies to electronic protected health information (e-PHI). A covered entity is responsible for maintaining confidentiality, integrity and availability of all e-PHI. Under the HIPAA Security Rule, covered […]
Are Your Patients Involved In Medical Record Accuracy?
Under HIPAA Privacy Rules, every individual has the right to request an amendment to their protected health information (PHI) if thought to contain inaccuracies. The healthcare provider or health plan must respond to the request but is not obligated to make the correction if they do not agree with the individual’s request. Documentation of this […]
OIG Special Fraud Alert Regarding Laboratories Payments to Referring Physicians
The OIG scrutinizes referring physician and laboratory arrangements. Two scenarios that involve transfer of value from laboratories to physicians are highlighted. These scenarios could represent possible fraud and abuse under the anti-kickback statute. Specifically, this addresses blood specimen collection, processing, and packaging and submission of patient data to a registry or database. The anti-kickback statute offers […]
Compliance with the Hazard Communication Standard
The goal of OSHA’s Hazard Communication Standard (HCS) is to “ensure that the hazards of all chemicals produced or imported are evaluated and that information concerning their hazards is transmitted to employers and employees. This transmittal of information is to be accomplished by means of comprehensive hazard communication programs, which are to include container labeling […]
