Compliance Officers and Compliance Committees
In many practices, a physician (or the physician in a solo practice) is named the compliance officer. In other practices, it is a senior staff member, often the office manager. And sometimes the compliance officer does not have any other duties in the organization, particularly in large practices.
Ophthalmology Audits: Is Your Practice Ready for a Medicare Audit?
Last month, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) released a study entitled “Questionable Billing for Medicare Ophthalmology Services.” As the study findings reflect, the OIG concluded that for the year 2012, approximately $171 million of the Medicare payments made that year for ophthalmology services were improper.
ZPIC Audits and Their Use of the Fraud Prevention System
The Department of Health and Human Services (HHS) is required to conduct a review of payments for Medicare fee-for-service claims by using “predictive analytics technologies” every three years. Perhaps the best known example of these “technologies” currently in use is the Fraud Prevention System (FPS) utilized by the Centers for Medicare and Medicaid Services (CMS) and the Zone Program Integrity Contractors (ZPICs) under its direction.
How has your Home Health Agency Implemented the New Face-to-Face Rules?
Many agencies have expressed relief that, effective 01/01/15, CMS mostly eliminated the narrative component of the face-to-face requirement. As most agencies readily understand, the narrative rule was hopelessly vague and not interpreted or applied consistently by the Medicare contractors. Unfortunately, the new version of the F2F regulation may not afford agencies the relief from improper claim denials that they have been hoping for.
Health Law ArticlesCompliance Officers and Compliance Committees Medicare Fraud: Texas Health Care Fraud Enforcement Efforts Continue to Rise Ophthalmology Audits: Is Your Practice Ready for a Medicare Audit? ZPIC Audits and Their Use of the Fraud Prevention System How has your Home Health Agency Implemented the New Face-to-Face Rules? Read More Posts From This Category
Dental Law ArticlesMedicare Dental: Significant Overpayments Have Been Made to Hospitals Dentists Participating in the Medicaid Program Must Exercise Caution to Avoid False Claims Act Liability Medicaid Dental Audit: Exclusion Screening Issues Dental Fraud Settlement — $5.05 Million to be Paid by Oklahoma Dental Practice in Medicaid Case. Medicaid Dental Fraud: Is the State of Texas Partly to Blame? Read More Posts From This Category
False Claims ActFalse Claims Act: Whistleblower Cases Have Continued to Rise Since the Passage of the Affordable Care Act
Number of whistleblowers on the rise (March 3, 2015): The federal False Claims Act... [Read more of this review]Dental Fraud Settlement — $5.05 Million to be Paid by Oklahoma Dental Practice in Medicaid Case.
(November 10, 2014): Dental fraud investigations and audits are becoming increasingly... [Read more of this review]OCR to Covered Entities, Business Associates: Encryption Is Your Best Defense against HIPAA Violations
(May 29, 2014) On April 22, 2014, the U.S. Department of Health and Human Services... [Read more of this review]Read More Posts From This Category
Business & Transaction ArticlesCell Tower Ground Lease Renewals and Purchases
A landowner/ground lessor considering a renewal or easement buyout of his cell tower... [Read more of this review]Cloud Storage Providers & BAAs – Where is Your Data?
In a recent webinar presentation, I was asked whether I believed one of the many... [Read more of this review]OIG Proposes New Anti-Kickback Law Safe Harbors
(November 10, 2014): The U.S. Department of Health and Human Services Office of Inspector... [Read more of this review]Read More Posts From This Category