Fraud and Abuse
05/20/2013
A new advisory bulletin from the HHS Office of Inspector General (OIG) spells out more clearly what the government expects you to do to avoid billing for services provided or ordered by excluded individuals. Billing for such services is subject to penalties of up to $10,000 per item or service furnished by the excluded individual, plus three times that amount in damages and loss of your Medicare certification.
 
05/13/2013
Some home health agencies that recently had their request for anticipated payment (RAP) dollars suppressed by Medicare administrative contractor (MAC) Palmetto GBA will be immediately eligible for reinstatement.
 
04/29/2013
Prepare for more record requests from recovery auditors (RACs): Starting in 2014, a new RAC will focus its attention exclusively on home health, hospice and durable medical equipment providers.
 
04/29/2013
A revamped version of the HHS Office of Inspector General’s (OIG) voluntary provider Self-Disclosure Protocol is designed to provide more guidance to agencies about what to report from the get-go and to shorten the process to less than a year.
 
02/25/2013
If you got a comparative billing report (CBR) in January, get ready for another: The initial reports sent by CMS contractor SafeGuard Services contained errors that will be corrected in new versions the contractor plans to send around Feb. 25. Once you get that corrected report, use it to shape your internal audits and staff training.
 
02/11/2013
Don’t rely on your Medicare administrative contractor (MAC) to adjust claims for late episode payments. Those payments could make a difference of hundreds of dollars per episode.
 
02/11/2013
Get ready for more Medicare recoupment, this time for past services provided to “aliens not lawfully present in the U.S.” But if you’re trying to identify unlawfully-present beneficiaries proactively to prevent future recoupment, you may be out of luck. 
 
01/28/2013
New data show the percentage of 13-visit episodes is trending upwards, raising the possibility of targeted auditor reviews that could cost your agency $300 or more per episode.
 
01/07/2013
CMS contractors’ performance in tracking down and preventing fraudulent home health payments varies widely between jurisdictions, a new analysis by the HHS Office of Inspector General (OIG) has found.
 
01/07/2013
The string of new home health issues posted by recovery auditors (RACs) continues: Region C RAC Connolly received CMS approval for three new issues in late November, including an investigation into timely OASIS completion.
 

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