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Many MAOs have overplayed the significance of this decision. On Sept. 7, in federal district court in Washington, D.C., in a case in which the Medicare Advantage Organizations (MAOs) in the UnitedHealth Group family of companies sued Alex Azar, the Secretary for the U.S. Department of Health and Human Services…
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MAs are taking advantage of excessive denials to reduce payments to providers. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently found that between 2014 and 2016, a total of 75 percent of all appealed Medicare Advantage (MAs) denials were overturned, equivalent to roughly…
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The government of Puerto Rico's official Hurricane Maria death toll at 2,975. The 2017 hurricane season devastated entire regions of the globe, especially states and territories of the United States. Harvey, Irma, and Maria were a storm trifecta that yielded losses so profound, the communities in their paths will be…
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The 340B drug pricing program has suffered a major setback. The axe fell on the American Hospital Association (AHA) and on hospitals across the country when the U.S. Court of Appeals dismissed a key AHA lawsuit on Tuesday. Following what can only be called a tempestuous journey, the fight against…
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Federal officials said the health system received overpayments of at least $2.4 million from 2014 through 2016. The University of Wisconsin Hospitals and Clinics Authority has found itself the target of an audit by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) for improperly…
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CMS offers advice through its Medicare Learning Network Connects bulletin to avoid coding errors. Mistakes happen, and errors do occur in the coding industry. The May 24 Centers for Medicare and Medicaid Services (CMS) Medicare Learning Network (MLN) Connects bulletin included provider compliance information that is noteworthy and important to…
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Improper use of extrapolation statistics is stunningly egregious, according to the author. Over the years, I have written extensively about the statistical extrapolations that are a large part of the audit process. In general, auditors—both government and private—make use of the extrapolation to significantly increase the overpayment estimates imposed on…
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HRSA claims delay will have no impact on current stakeholders. The Health Resources and Services Administration (HRSA), which administers Section 340B of the Public Health Service Act, has published a proposal to delay for another year the ceiling price and civil monetary penalties regulation that was originally issued by the…
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If this hospital was targeted by the DOJ, where does that leave everyone else? Today I have a great mystery to present. Last week the U.S. Department of Justice (DOJ) announced a $1.88 million False Claims Act settlement with Genesis Medical Center in Davenport, Iowa. In the settlement, the DOJ…
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OIG audits device credit reporting. The confluence of two major healthcare news stories is creating confusion among providers. News of changes to the national coverage determination (NCD 20.4) for implantable cardioverter defibrillators, as first reported by Ronald Hirsch, MD, for RACmonitor, nearly collided with a report on device credit from…