On November 14, 2011, the U.S. Attorney's Office for the Southern District of Texas announced that a physician was sentenced for fraud regarding private insurance, Medicare and Medicaid. Armando Chavez, a former physician and owner of the Chavez Medical Group in East Houston, was sentenced to 60 months for conspiracy and 70 months for each of three mail fraud charges, all to run concurrently. Chavez was also ordered to pay $3,821,082 in restitution. The charges stem from improper billing at the … [Read more...] about Former Houston Physician Sentenced to Federal Prison for Mail Fraud Related to Private Insurance Billing
Four Habits of High-Value Health Care Organizations
The New England Journal of Medicine recently published an article regarding four habits of effective hospitals. Although the article is geared towards, hospitals, the principles below are applicable to any health care organization. Specification and planning - Base choices, transitions, subgroups, and patient pathway on specific, meaningful criteria. Infrastructure design - Create microsystems to meet the needs of patient sub-populations. The author stresses that microsystems create "an … [Read more...] about Four Habits of High-Value Health Care Organizations
Fall 2011 OIG Semiannual Report to Congress
The Office of the Inspector General ("OIG") recently issued its semiannual report for the period ending September 30, 2011. The report provides an overview of the enforcement actions over the past year. Of particular interest is the report's section of hospice care. Hospice care for nursing facility residents has grown nearly 70% since 2005. The OIG recommends that CMS monitor hospices that depend heavily on nursing facility residents and modify the payment system for hospice care in nursing … [Read more...] about Fall 2011 OIG Semiannual Report to Congress
ILs/News Alerts: HIPAA, HSC Billing Training
DADS released two information letters and two news alerts: Most LTC providers: HIPAA rules mandate that all Electronic Data Interchange (EDI) transactions must use EDI Version 5010. CMS has extended the December 31, 2011, compliance deadline until April 1, 2012. (Letter) ICF/MR: DADS reminds providers of their responsibility to maintain current and accurate information in ICF/MR Provider Characteristics using Client Assignment and Registration Screen 683 and the instructions for … [Read more...] about ILs/News Alerts: HIPAA, HSC Billing Training
Would Green Smoothies be better than Ensure for Nursing Home Residents?
http://youtu.be/KLjgBLwH3Wc One interesting video deserves another. http://www.youtube.com/watch?v=emd_wKeQjxI … [Read more...] about Would Green Smoothies be better than Ensure for Nursing Home Residents?
TX Register Updates: Managed Medicaid Care Expansion
The following information was obtained from the December 23 issue of the Texas Register. Proposed Rules HHSC proposed rules for several sections of the code: Medicaid Managed Care – HHSC proposed to amend, repeal, and add new rules to several subsections to Chapter 353, Medicaid Managed Care. An excerpt: The amendments and repeals are also proposed to delete references to the Integrated Care Management (ICM) program. ICM was a Texas Medicaid managed care program designed to address the … [Read more...] about TX Register Updates: Managed Medicaid Care Expansion
Medicare/Medicaid News
Medicaid cut challenges will get a hearing in Arizona. "Three public-interest law groups challenged an enrollment freeze for childless adults in the state's Medicaid program, the Arizona Health Care Cost Containment System. A lower-court judge and an Arizona appeals-court panel upheld the cuts and state lawmakers enacted the freeze as part of $500 million in AHCCCS reductions to help balance the current-year budget." - AZ Central States test health care reform flexibility. Essential benefits, … [Read more...] about Medicare/Medicaid News
IL/News Alerts: Waiver Form Revisions, January 3 Meeting
CLASS, CMA, and DSA DADS will review all forms used across DADS waiver programs, including CLASS forms used by CMAs and DSAs, which will be reviewed and revised in phases. Stakeholders will have a chance to review revisions before forms are updated. (Letter) -- CMS has posted the "November 3, 2011 National Provider Call Follow-Up and Clarifications" on its website at this link. DADS urges providers to read the document to help complete the assessments correctly. -- DADS has posted a … [Read more...] about IL/News Alerts: Waiver Form Revisions, January 3 Meeting
TX Register: Medical Board Updates
The following information was obtained from the December 16 issue of the Texas Register. Public Notice HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance to update the current plan with recent fee schedule updates, including fees for new services and modified fees for existing services. See the Texas Register for more information. Withdrawn Rules The Texas Medical Board has withdraw the proposed amendment to §177.5, which appeared in the September 30, … [Read more...] about TX Register: Medical Board Updates
Three Felonies A Day Redux
Some time ago, I wrote about Harvey Silverglate's book Three Felonies A Day: How the Feds Target the Innocent. The book's premise is that there is virtually no adult in this country who has not violated a federal criminal law because of the incredible number of laws and the vagueness and breadth of them. Moreover, almost every Federal regulation carries criminal consequences either directly or through piggy-backing with a statute.This should be of particular concern to health providers … [Read more...] about Three Felonies A Day Redux
