Medicare, Medicaid & Private Payor Updates

The AHA Expresses its Concerns with Recent False Claims Act Kyphoplasty Cases

Medicare, Medicaid & Private Payor Updates /

(September 11, 2010): The American Hospital Association (AHA) has expressed its concern that the Department of Justice (DOJ) and its law enforcement partner, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) may be overreaching in its use of the False Claims Act in kyphoplasty cases. As set out in the AHA’s […]

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HHS-OIG Issues Report on Improper Claims for Nonemergency Transportation Services

Medicare, Medicaid & Private Payor Updates /

(September 6, 2010): The Department of Health and Human Services, Office of Inspector General (OIG) recently issued its report examining the costs of nonemergency transportation services reimbursed by Medicaid. Pursuant to 42 C.F.R. § 431.53, Texas and other States are required to ensure that Medicaid patients have transportation to medical facilities and providers to obtain

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HHS-ONC Names EHR Certification Bodies

Medicare, Medicaid & Private Payor Updates /

(September 1, 2010): Earlier this week, the Office of the National Coordinator for Health Information Technology (ONC), an organization within the Office of the Secretary of the Department of Health and Human Services (HHS), has named two entities as EHR Certification Bodies. They include: The Certification Commission for Health Information Technology (CCHIT), Chicago, Illinois, and

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DOJ is Using Medicare Billing Data to Target Health Care Providers

Medicare, Medicaid & Private Payor Updates /

(August 31, 2010): Last week, department heads of the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS), met in Los Angeles, CA and conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” Following-up on a similar conference held in Miami, DOJ Attorney General Eric

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Health Data Insights Begins Medical Necessity Reviews

Medicare, Medicaid & Private Payor Updates /

(August 30, 2010): Health Data Insights (HDI), the Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC) responsible for auditing health care providers in Region D, has announced it will immediately begin reviews on previously approved projects which involve the medical necessity of selected inpatient DRG payments. A complete list of the medical

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Additional Cities will have HEAT Teams in 2011

HEAT Strike Force, Regulatory Issues | Privacy | Other /

(August 27, 2010): Additional cities will be getting Medicare fraud HEAT teams. Yesterday, Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” In addition to these agency heads, participants learned of current and

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Region B RAC CGI Announces that it will Begin Review of Eighteen Projects that Involve Medical Necessity

Medicare, Medicaid & Private Payor Updates /

(August 25, 2010): CGI Technologies and Solutions, Inc., (CGI), has announced it will immediately begin reviews on 18 newly approved projects that involve the medical necessity of selected inpatient DRG payments. A complete list of the “issues” currently being examined by CGI can be found on its website. Recovery Audit Contractors (RACs), such as CGI,

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CMS Issues Medical Record Retention Reminder: MLM Matters SE1022

Medicare, Medicaid & Private Payor Updates /

(August 17, 2010): Last week, the Centers for Medicare and Medicaid Services (CMS) issued MLM Matters SE1022, titled “Medical Record Retention and Media Formats for Medical Records” directed toward physicians, non-physician practitioners, suppliers, and other health care providers submitting claims to Medicare contractors for services provided to Medicare beneficiaries. As CMS acknowledged, medical record retention

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Multiple Texas Health Care Providers and Suppliers Charged in DOJ’s June 2024 Strike Force Takedown

HEAT Strike Force, Medicare, Medicaid & Private Payor Updates /

(July 11, 2024): Last week, the Department of Justice (DOJ) announced that it has criminally charged 193 defendants with violations of various health care fraud statutes. The government estimates that the fraudulent schemes employed by the defendants resulted in losses of $1.6 billion to Federal, State, and private payor health care programs. These cases are

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South Texas Medicare Providers are Under the ZPIC Microscope

Medicare, Medicaid & Private Payor Updates /

(July 16, 2010): If there were ever any doubts that ZPICs are going to make their presence known in South Texas now that they have replaced PSCs,those doubts can be put to rest. Health Integrity LLC, the Zone 4 contractor, is proving to be an active and aggressive auditor of physician practices, physical therapy services,

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