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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…
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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.
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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…
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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…
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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)…
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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…
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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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There is no doubt that state Medicaid Fraud Control Units (MFCUs) have their hands full and are charged with a difficult task. They are responsible for investigating Medicaid fraud. This is part of the responsibility assigned to them by the Centers for Medicare & Medicaid Services (CMS) as a mandate for…
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The Centers for Medicare & Medicaid Services (CMS) will be changing the criteria for short-stay audits in April, according to KePRO, one of the Medicare Quality Improvement Organizations (QIOs), which posted the announcement on its home Web page.“CMS is changing the selection process for medical records for short-stay reviews,” the…
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With unusual bipartisan support, a new piece of legislation of about 1,000 pages was signed into law on Dec. 13, 2016 – the 21st Century Cures Act. The Act will allocate about $6 billion to a variety of medically related needs. While the bill has received both applause and criticism…