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No one is free from audits. Even auditors get audited. When the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audits auditors, however, the auditors get recommendations for changes, not the million-dollar penalties that healthcare providers receive. In September 2020, OIG released an audit report…
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The ousting of Christi A. Grimm comes amid a series of OIG removals, developments that are concerning lawmakers and editorial boards alike.   “The first messenger that gave notice of Lucullus’s coming was so far from pleasing Tigranes, that he had his head cut off for his pains; and no…
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The former HHS Inspector General and AHA have rallied to the defense of the report’s architect.   A report issued this week by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) describes a dystopian scenario of American hospitals reeling badly from the COVID-19 viral…
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Overzealous and hyper-aggressive audit tactics are scaring providers away from self-governing. The U.S. Department of Health and Human Services (HHS) strikes again, and this time, based on an Office of Inspector General (OIG) audit, Saint Francis Health Center has been asked to refund $5.5 million back to the Medicare contractor. …
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The OIG has instructed MACs to recoup the entire DRG payment on claims dating back to 2016. EDITOR’S NOTE: The RACmonitor special bulletin of Jan. 30, “News Alert: Widespread Recoupments of Incorrect Post-Acute Transfer Claims Have Begun,” is prompting alarm among hospitals, as evidenced by the response from Dr. R.…
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Often overlooked is the line-item price reduction step, particularly related to partial or 50 percent-or-greater credits. It was inevitable: just when hospitals were getting comfortable with their policies and procedures for reporting implantable medical device credits, even to the point of congratulatory back-slaps for meticulously following all related compliance steps,…
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MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG.  The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a study that should cause a chill to run down the spines of hospital and Medicare Advantage plan leaders alike.…
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Three risks, in particular, are expected to pose a greater liability for providers. As we get ready to say goodbye to another year of audits and investigations, compliance officers around the country have worked or are working to determine their audit elements for calendar year 2020, in response to the…
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There are resources available to help prevent wrongdoers from successfully targeting vulnerable patient populations. A dirty little secret of the long-term care industry is that the problem of identity theft arises more often than is reported.  In all fraud, there is the fraud triangle. The triangle sides are pressure, opportunity,…
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More than 700 pages of text make up proposed changes to the federal Stark and anti-kickback statutes. On Wednesday, Oct. 9, federal healthcare officials announced two new proposed rules.  While the main focus of both proposals is to remove perceived legal barriers to various value-based reimbursement models and facilitate care…