Nancy J. Beckley, MB, MBA, CHC | June 29, 2016

Manual Medical Review – A Horse of a Different Color

Here we go again, therapy providers. Brace yourself for profiling, data analytics, a new manual medical review process, and yet another contractor assigned to the task of scrutinizing services. In other words, this is a horse of a different color.  The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law on April 16, 2015, extended the therapy cap exception process through Dec. 31, 2017 and modified the requirement …

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David M. Glaser, Esq. | June 29, 2016

We Just Disagree

Dave Mason once famously sang, “there ain’t no good guy; there ain’t no bad guy. There’s only you and me and we just disagree.”   That notion can get lost in the world of compliance, where people often fear that disagreeing with a government position is tantamount to heresy. That point was driven home for me while reviewing evaluation forms from this year’s annual Health Care Compliance Association (HCCA) meeting in …

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Ronald Hirsch, MD, FACP, CHCQM | June 29, 2016

CMS Tries to Stop Home Care Fraud Before it Happens

Last week was a busy week in the news: affirmative action survived the Supreme Court, immigration amnesty did not, seemingly everyone except Donald Trump was surprised by the Brexit vote results, and Cleveland won a championship. Yet with all that, there was still time for the U.S. Department of Justice to announce its record Medicare fraud takedown, which involved $900 million in false billings and charges against 301 individuals, including …

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06.22.2016
DEVELOPING: Feds Announce Charges in Historic Healthcare Fraud Takedown
DEVELOPING: Feds Announce Charges in Historic Healthcare Fraud Takedown

Federal authorities on Wednesday announced what they described as the culmination of an “unprecedented” multi-jurisdiction healthcare fraud investigation resulting in approximately 300 arrests tied to $900 million in fraudulent billing. Both totals were records for the federal Medicare Fraud Strike Force, which led the way in making arrests in 36 federal districts, U.S. Attorney General Loretta E. Lynch and Department of...

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06.22.2016
GAO: Persistent Issues with the Medicare Appeals System and the Growing Backlog of Appeals
GAO: Persistent Issues with the Medicare Appeals System and the Growing Backlog of Appeals

On June 9, 2016, the Government Accountability Office (GAO) publicly released its report, “Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process” (Report). The Report addresses persistent issues within the Medicare appeals system that contribute to the growing backlog of pending appeals. The Report also highlights support for the Audit & Appeal Fairness, Integrity and Reforms in Medicare (AFIRM) Act of...

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06.22.2016
The Flawed Regime
The Flawed Regime

EDITOR’S NOTE: U.S. Attorney General Loretta E. Lynch and U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell yesterday announced an unprecedented nationwide enforcement initiative led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals – including 61 doctors, nurses, and other licensed medical professionals – for...

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06.22.2016
The New Supreme Court Decision – and Why it’s a Big Deal
The New Supreme Court Decision – and Why it’s a Big Deal

A case related to a failed Medicare and Medicaid Advantage plan was decided 8-0 against the plan by the Supreme Court last week. The case arose when Massachusetts Medicaid discovered that some of the mental health counselors billing the plan were not licensed to provide the services they were providing. It became a FCA issue because the plan paid the claims,...

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OIG

OIG Work Plan: Fair Warning

Chuck Buck | 11.04.2015

OIG Work Plan: Fair Warning

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) 2016 Work Plan comes with a warning: the OIG continues to be relentless in detecting and...

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Feature Articles

DEVELOPING: OIG Puts Home Health Care in…

Chuck Buck | 06.29.2016

DEVELOPING: OIG Puts Home Health Care in the Crosshairs

The business of healthcare was thrust into the national spotlight last Wednesday with a media triple play. U.S. Treasury Secretary Jack Lewis reported that the Medicare trust fund will dry up...

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IRF

Nordian Posts Results of Recent Oregon P…

Angela Phillips, PT - avatar Angela Phillips, PT | 05.04.2016

Nordian Posts Results of Recent Oregon Probe Audit:  Once Again, No Surprises for IRFs in the Results

Last month, we discussed Noridian’s findings from the IRF Probe Audit for Arizona conducted from December 21, 2015, through March 3, 2016. At that time, we agreed to provide the...

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