Medicare Compliance

Preparing for Hospital Price Transparency Rule Compliance

by Jacqueline LaPointe

A global pandemic may not be enough to stop one of CMS’ more controversial rules from taking effect in just a couple of months. On January 1, 2021, US hospitals will need to comply with the...

CMS Doles Out $15M in Fines to Nursing Homes During COVID-19

by Jacqueline LaPointe

CMS recently announced that more than 3,400 nursing homes were fined because of noncompliance with infection control requirements and failure to report COVID-19 data during the public health...

Breaking Down Proposed Changes to Anti-Kickback, Stark Law

by Jacqueline LaPointe

HHS recently made moves to update the Stark Law and Anti-Kickback Statute, two healthcare fraud rules created decades ago that have prevented physicians, hospitals, and other healthcare providers from...

Hospitals Take Aim at Healthcare Price Transparency Proposal

by Jacqueline LaPointe

A healthcare price transparency rule proposed earlier this year by CMS aims to empower patients by requiring the public disclosure of rates negotiated by hospitals and payers. But hospitals and other...

DoJ Probes Swedish Health Services About Joint Ventures, Other Deals

by Jacqueline LaPointe

The US Department of Justice (DoJ) is investigating Providence St. Joseph’s Swedish Health Services over a civil issue, the non-profit disclosed in its recent quarterly earnings report. The DoJ...

CMS: Cut Red Tape to Lower Healthcare Costs, Boost Competition

by Jacqueline LaPointe

Reducing the regulatory burden of practicing medicine is critical to decreasing the high healthcare costs produced by provider consolidation, CMS Administrator Seema Verma recently...

Should Medicare Accrediting Organizations Also Provide Consulting?

by Jacqueline LaPointe

CMS is questioning if the financial relationships between Medicare accrediting organizations and providers are impacting the accreditors ability to accurately determine if providers are fit to...

Medicare Improper Payment Rate Down to 8.12%, Lowest Since 2010

by Jacqueline LaPointe

CMS recently reduced the Medicare improper payment rate as well as the improper payment rates for Medicaid and the Children’s Health Insurance Program (CHIP) for the first time in reporting...

OIG Identifies Several Quality Improvement Challenges at IHS

by Jacqueline LaPointe

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recently identified several quality improvement challenges at Indian Health Services (IHS) hospitals, including...

Strong Compliance Programs Key to Avoiding Healthcare Fraud

by Jacqueline LaPointe

Preventing and catching healthcare fraud schemes has recently jumped to the forefront of many public and private payer programs that are designed to reduce unnecessary healthcare spending. The...

Hospital Claims $173,000 in Medicare Overpayments

by Stephanie Reardon

Hospital did not fully comply with Medicare requirements for billing inpatient and outpatient services. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the...

Medicare Overpays Hospital $414,000 for Incorrect Medical Billing

by Stephanie Reardon

The Hospital did not fully comply with Medicare requirements resulting in approximately $414,000 in overpayments for incorrect medical billing. The Department of Health and Human Service (HHS) Office...

California State Agency Claims $375,000 in Non-Compliant Medicaid Fees

by Stephanie Reardon

Out of 100 beneficiary-services six had not complied with federal regulations leading to over payment in Medicaid fees. The Department of Health and Human Service (HHS) Office of Inspector General...

CMS Paid $35.2M in Non-compliant Claims

by Stephanie Reardon

Medicare paid approximately $35.2 million in 2010 in non-compliant claims for PMD. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its...

CMS Audit Finds $17.6M Overstated for Excess Plan

by Stephanie Reardon

CMS audit discovers BCBS South Carolina overstated its allocable Excess Plan costs by approximately $17.6 million. The Department of Health and Human Service (HHS) Office of Inspector General (OIG)...

How can CMS Reform the Medicare Hospice Payment System?

by Stephanie Reardon

CMS must update the Medicare hospice payment system using the data gathered by this audit in order to meet the ACA requirements. The Department of Health and Human Service (HHS) Office of Inspector...

CMS Restricts Ambulance Services for Improper Medicare Billing

by Stephanie Reardon

New Medicare billing regulation could limit the number of allowable ambulance transports and could reduce the revenue intake for ambulance services. Ambulance companies in New Jersey are in a bind....

CMS Changes Medicare and Medicaid Audit Process

by Stephanie Reardon

CMS paid nearly $4 billion in improper Medicare payments. The Centers for Medicare & Medicaid Services (CMS) announced that it has expanded its contracts to four different companies –...