Fraud and Abuse
12/24/2012
Close scrutiny by the HHS Office of Inspector General (OIG) and CMS contractors made 2012 a challenging year for home health compliance, and 2013 is unlikely to be better.
 
12/10/2012
Three out of CMS’ four recovery auditors (RACs) have now posted complex review topics for home health agencies, and at least one agency already is starting to feel the auditors’ scrutiny.
 
12/03/2012
A new report from the HHS Office of Inspector General (OIG) means agencies likely will see CMS and its contractors participate more actively in administrative law judge (ALJ) hearings in an attempt to uphold denials. However, experts believe the ALJs’ traditional independence from HHS could work in providers’ favor.
 
11/05/2012
Demonstrate that the care you provide to assisted living facility (ALF) patients doesn’t duplicate services provided by ALF staff to prevent overpayment demands from zone program integrity contractors (ZPICs).
 
10/15/2012

Months after a $375 million fraud indictment, the Department of Justice (DOJ) has unsealed two new indictments alleging large-scale fraud based on phony physician referrals in the Dallas area.

10/08/2012

There’s a new reason to update your compliance program: Government auditors are devoting greater attention to providers who bill for services provided by individuals who have been excluded from Medicare or Medicaid.

09/24/2012

Starting Jan. 7, 2013, the CMS claims processing system will automatically identify high-risk claims before they’re paid – a development that could lead to new pre-payment ADRs for agencies.

09/03/2012

Want more referrals? One Florida agency is negotiating an agreement with a “regional physician group” to be the group’s “home health agency of choice for patients in need of home health services.”

09/03/2012

Details of Home Health International’s physician agreement aside, another question is the agency’s physical location.

08/27/2012

A lawsuit challenging the appropriateness of bonuses paid by a Lincolnwood, Ill.-based agency is raising questions about the future of employee safe-harbor provisions of the anti-kickback statute.

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