One way act this act will affect Physicians and their practices with new provisions regarding fraud and abuse with a section entitled "Eliminating Kickbacks in Recovery." This resembles the federal Anti-Kickback statute with some important differences. Its purpose is to (1) Curtail patient's brokering with opioid treatment centers and to (2) slow the overutilization of laboratory toxicology screenings by closing a loophole in the Anti-Kickback statutes. Physicians who have ownership … [Read more...] about How will the SUPPORT Act Affect Physicians and Their Practice?
CMS authorizes increase of $340 million in Hospice payments for FY 2019
Many families and health care providers are debating whether the Centers for Medicare and Medicaid Services, which runs Medicare (CMS) and Congress are doing enough to implement processes to protect patients and their families from hospice providers who may be exploiting the service. Recently, CMS finalized a $340 Million/ 1.8 percent increase in Hospice payments for Medicare Hospice providers. According to reports, the Office of Inspector General (OIG) at HHS synthesized 10 years of … [Read more...] about CMS authorizes increase of $340 million in Hospice payments for FY 2019
HHS Releases Report on Hospice Care Fraud in US
A report released recently released by the Office of Inspector General (OIG) at the US Department of Health titled: Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity has highlighted that hospice care fraud is a nationwide problem in the US. The report found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care for Nursing home residents and other patients. When care is provided hospices’ inappropriate … [Read more...] about HHS Releases Report on Hospice Care Fraud in US
Trump Signs Electronic Visit Verification (EVV) Into Law
With no opposition from the House or Senate, the U.S. Senate unanimously approved legislation of the H.R.6042 bill delay the nationwide deadline for electronic visit verification (EVV) or ( in-home health service bill) in Medicaid-reimbursed personal care services until 2020. President Donald Trump signed Rep. Brett Guthrie’s health care bill into law on July 30th. According to news reports, the 21st Century Cures Act, initially signed into law in 2016 under the Obama Administration, … [Read more...] about Trump Signs Electronic Visit Verification (EVV) Into Law
Abuse & poor quality care rate in Texas nursing homes is nearly four times the national average
Many nursing homes have hired Certified Nurse Aides with criminal histories legally. Using data from the federal Centers for Medicare and Medicaid Services, it has been discovered that the patient abuse rate in Texas nursing homes is nearly four times the national average. 25% of the state's 1,200 long-term care centers have been cited for serious standard deficiencies- According to reports by the AARPIn Texas, there are many nurse aides in nursing facilities that have criminal … [Read more...] about Abuse & poor quality care rate in Texas nursing homes is nearly four times the national average
Medicaid and Managed Care–Who Benefits?
Is Medicaid really broke? If not, who is making money where Managed Care is involved? According to this, not the providers. Is this ignored so that attention is focused on allegations of fraud by providers? … [Read more...] about Medicaid and Managed Care–Who Benefits?
OIG Launches Compliance 101 Website
On March 5, 2005, the Office of the Inspector General ("OIG") launched its Compliance 101 website. The website contains links to guidance and educational training materials for health care providers, practitioners and suppliers. The site contains segment-specific compliance guidance for nursing facilities, ambulance suppliers, physician practices, etc. Although the materials are from 1998-2008, the compliance program guidance is still relevant and details the high-risk areas for each health … [Read more...] about OIG Launches Compliance 101 Website
Medicare Fraud Strike Force in Texas
According to the Houston Chronicle, there's a federal Medicare fraud strike force on the loose in Texas. The article highlights a number of Houston-area clinics committing Medicare fraud. Medicare fraud in the U.S. last year totaled $2.35 billion. There were 575 health fraud criminal actions and 342 civil actions filed. The task force has reduced identification of Medicare fraud from months to days, thanks to improved technology. Justice Department spokeswoman Melissa Schwartz said, "There … [Read more...] about Medicare Fraud Strike Force in Texas
Private Lawsuits Under the False Claims Act
The recent decision in United States v. Regence Blue Cross (10th Cir 12/05/2006) illustrates the power of qui tam, or private, civil lawsuits under the False Claims Act (FCA). Under the FCA, an action can be commenced either by the United States itself, or as a “qui tam†action, by a private person acting “for the United States Government†against providers “in the name of the Government.†The false claim may take many forms: overcharging for a product, failing to perform a service, … [Read more...] about Private Lawsuits Under the False Claims Act
The False Claims Act–A Significant Hammer!
For an example of how whistleblowers and the False Claims Act interact, read this article, Home Health Care Industry Reels from Medicare Scandal. Whistleblowers can bring qui tam lawsuits against providers and benefit hugely. In this particular case, the whistleblower benefits as follows: The False Claims Act permits individuals to file qui tam lawsuits against companies that defraud the government. Liable companies pay as much as three times the government's losses plus penalties for … [Read more...] about The False Claims Act–A Significant Hammer!
