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CMS cited by GAO for insufficient documentation. The Government Accountability Office (GAO) issued a report on March 27 stating that the Centers for Medicare & Medicaid Services (CMS) should assess documentation necessary to identify improper payments. The study was performed on Medicare and Medicaid fee-for-service (FFS) improper payment data for…
Major takedown by DOJ sends shivers through skilled nursing facilities. Philip Esformes, the operator of 16 skilled nursing and assisted living facilities in South Florida, was found guilty Friday of 20 charges, including paying bribes and kickbacks to bring Medicare patients into his businesses. According to Assistant Attorney General Brian…
The head of the federal healthcare oversight body was a popular guest on Monitor Mondays. Daniel Levinson, Inspector General of the U.S. Department of Health and Human Services (HHS), is stepping down from his post at the end of May, following nearly 15 years in his position as healthcare’s top…
Suggestions for conducting peer-to-peer appeals for denials If you are wondering why you should read this if you think you are not a rebeginner, well, it is because you actually are one. Beginnings do not disappear, they just reproduce. Novices are just starting, veterans have started over and over. We…
AI tools include anomaly detection, predictive analysis, and social network analysis. Medicare fraud is a serious issue and an expensive one. “Improper payments” amount to more than $52 billion per year. Our government uses subcontractors to do its work. They have corrected around $500 million (half a billion dollars) in…
Hospitals may consider abandoning their contracts. There are few things managed Medicare plans have come up with that are more unfair to hospitals than denials due to readmission. Hospitals with contracts with managed Medicare payers often must endure these denials, as they are not often excluded in contracts. Managed Medicare…
Plaintiffs allege they were forced to pay thousands for SNF care following outpatient/observation status assignment. A federal judge has denied the government’s bid to put a stop to a landmark class-action lawsuit centering on patient status, paving the way for a trial expected to begin later this year. In Alexander…
Safety-net providers once often overcharged for medications covered under the federal cost-saving program have a new resource to protect against it. The Health Resources & Services Administration (HRSA) has launched a new secure website intended to serve as a tool through which safety-net healthcare providers participating in the 340B federal…