The Centers for Medicare & Medicaid Services (CMS) held an MLN Connects national provider call on June 29 to educate providers and interested parties on the U.S. Department of Health and Human Services (HHS) final rule to improve the Medicare appeals process. CMS and the Office of Medicare Hearings and…
EDITOR’S NOTE: The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) reported yesterday that Wisconsin Physicians Service Insurance Corporation (WPS) did not properly settle for federal fiscal years (FYs) 2010 through 2012 Medicare cost reports submitted by inpatient hospitals in Missouri for Medicare…
What’s the difference between $1.4 million and $42 million?  Well, before you get your calculators out, let me make this really easy. If you are like me, the difference is $40.6 million.  If you base your calculation on common core, however, it’s, well, wherever it leads you, as long as…
Each year the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases its annual Medicaid Fraud Compliance Performance Report. There is much to learn from this compendium of information provided by 50 Medicaid Fraud Control Units (MFCUs), and this article will highlight some of…
With 402 metrics listed in a 55-page guidance sheet, “HCCA-OIG Measuring Compliance Program Effectiveness: A Resource Guide" is a collection of best practices for measuring effectiveness at any U.S. healthcare facility.
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently conducted an audit of Mount Sinai Hospital in New York City. After looking at a sample, the OIG found fault with about $1.4 million in claims, and projected that to an overpayment of just under $42…
To a compliance officer, the words “corporate integrity agreement” (CIA) can send a chill up and down the spine. When you look at the true meaning and goal of a CIA though, you can see that its intent is not punitive, but instead a road map to make a healthcare…
EDITOR’S NOTE: Donna Thiel, former chief compliance officer and now director of the ProviderTrust compliance integrity division, participated in a roundtable conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). The following is her report.In late 2016, the Health Care Compliance Association (HCCA)…
Indeed, it was another “Dantastic” Monday as Inspector General Dan Levinson took the podium to deliver the keynote at the 21st Annual Compliance Institute in National Harbor, Maryland.  Dan opened with the discussion of a January Health Care Compliance Association (HCCA) U.S. Department of Health and Human Services Office of…
On the next edition of Monitor Mondays, Mary Beth Pace, vice president of care management at Trinity Health, will share how her health system is traversing the new compliance landscape of the MOON: the Medicare Outpatient Observation Notice, which became effective March 8. What are they discovering, and how are…
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