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 …Read more
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 …Read more
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 …Read more
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...Read more
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...Read more
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...Read more
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,...Read more
Outpatient therapy is in turmoil. Providers are under siege by government and commercial auditors because so many providers simply don't know the rules that will keep them compliant. This webcast can change all that…for good.
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