Fraud and Abuse Developments
-
OIG Advisory Opinion on DME-IDTF arrangements
On June 21, 2011, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) posted Advisory Opinion 11-08 regarding arrangements between a durable medical equipment (DME) provider and various independent diagnostic testing facilities (IDTFs) operating as sleep centers.The scenarios examined by the OIG involved existing and proposed arrangements between a Medicare-enrolled supplier of continuous positive airway pressure blower units, masks and supplies (CPAP) and several IDTF sleep centers. At issue in OIG Advisory Opinion 11-08 was whether the existing and proposed arrangements would constitute grounds for program exclusion, civil monetary penalties or violation of the Federal anti-kickback statute.Under the existing arrangements, when a private pay (non-federally insured) patient selects the ...
Posted Jul 6, 2011 3:15 PM by John Little
-
Sleep Center charged with using unqualified personnel
On
June 14, the DOJ announced that it had filed a complaint under the False Claims Act against Bay Area Sleep Associates LLC, dba SomnoMedics LLC, and its
owner, Edward Killmer Jr. The government’s complaint alleges that
beginning no later than 2004, the defendants hired unlicensed sleep
technicians to perform sleep tests at one or more of their facilities.
Medicare regulations require that diagnostic testing services performed
at independent diagnostic testing facilities such as SomnoMedics must
be performed by a technician licensed or certified by a state or
national credentialing body in order to be reimbursed by Medicare. The
complaint alleges that SomnoMedics utilized unlicensed sleep
technicians to perform sleep tests on Medicare and TRICARE
beneficiaries, but knowingly requested ...
Posted Jul 6, 2011 2:46 PM by John Little
-
Associated Press: Medicare goes high-tech to head off fraud
From the Associated Press. Washington - “Tired of paying bogus claims, then chasing the scammers, Medicare announced Friday it is deploying screening technology similar to what's widely used by credit card companies to head off fraud. Up to now, the $500 billion-a-year government health program for seniors has basically paid claims first and asked questions later in a system dubbed ‘pay and chase.’ … Medicare anti-fraud czar Peter Budetti said the new system expected to go into operation July 1 is a major step forward. ‘It will allow us to do some things we had not been able to do before,’ he said. … The new system will allow Medicare to monitor large numbers of claims using computer analysis ...
Posted Jul 6, 2011 2:20 PM by John Little
-
OIG Semiannual Report to Congress through March 2011
On
June 1, the Office of Inspector General (OIG), in its Semiannual Report
to Congress for October 2010 through March 2011, announced $3.4 billion
in new expected recoveries related to its investigations, audits, and
other reviews, mainly of Medicare and Medicaid. These expected
recoveries are largely made up of restitutions, fines, penalties, other
assessments, and settlements. The expected recoveries include about $222
million from audits and $3.2 billion arising from 349 criminal and 197
civil actions that were concluded during the period. OIG also excluded
883 individuals and entities from participating in Federal health care
programs during the same time frame. OIG's Semiannual Report to Congress
also highlighted the following:In
February 2011, more than 300 OIG ...
Posted Jul 6, 2011 2:02 PM by John Little
-
OIG issues its Work Plan for Fiscal Year 2011
The Office of Inspector General's (OIG's) annual Work Plan provides brief descriptions of activities that the office plans to initiate or continue with respect to the programs and operations of the Department of Health & Human Services (HHS) in fiscal year 2011. The work plan is a good resource for compliance officers to discern areas of audit and educational focus. Of particular interest to hospitals and physicians in the 2011 Work Plan, the OIG's reviews will include the following issues:
the appropriateness of hospitals claims of provider based status for inpatient and outpatient facilities, which permits the hospitals to receive higher reimbursement when they include the costs of a provider based entity on their cost reports.
the appropriateness ...
Posted Mar 11, 2011 12:10 PM by John Little
Health Information & Technology News
-
HHS issues clarifications for EHR certification
On
June 10, the DHHS’ Office of the National Coordinator for Health
Information Technology (ONC) issued the following clarifications with
regard to EHR certification:A combination of certified EHR Modules can be used to meet the definition of Certified EHR Technology.Combining
certified EHR Modules or certified EHR Modules with a certified
Complete EHR (or even two certified Complete EHRs) will not invalidate
the certification assigned to the EHR technologies.ONC-Authorized
Testing and Certification Bodies (ONC-ATCBs) are not required to
examine the compatibility of two or more EHR Modules with each other.The
ONC-ATCBs do not favor large developers, and such favoritism is
precluded by the international standards to which ONC-ATCBs must adhere.Certification
doesn’t ...
Posted Jul 6, 2011 3:01 PM by John Little
|
|
