Medicare made $36.2 billion and Medicaid $41.2 billion in improper payments in fiscal year 2017. That's the finding of a report from the Government Accountability Office (GAO) based on CMS estimates … [Read more...]
OIG
GAO: $77.3 Billion in Improper Medicare/Medicaid 2017 Payments, Including $1.82 Billion to Labs
April 23, 2019
Enforcement Trends: Opioid Crackdown Is Diverting Resources from Traditional OIG Enforcement Activities
December 14, 2018
The OIG won't admit it, but the opioid crackdown is diverting resources from traditional Medicare fraud and waste enforcement efforts. At least that's the most likely explanation for the dramatic … [Read more...]
COMPLIANCE GUIDANCE
Kickbacks: OIG Okays Incentivizing MDs to Order More Early Screening Tests
November 16, 2018
Proactive rather than reactive has become a mantra of the modern health care model. Early and periodic testing of patients is a critical element in this strategy. The problem is that not a lot of … [Read more...]
FEE SCHEDULES
OIG Backs CMS on PAMA Market Rate Setting—and the Lab Industry Is None Too Pleased
August 27, 2018
CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report examining the agency's work in carrying out its PAMA mandate of establishing market-based Medicare … [Read more...]
REIMBURSEMENT
Enforcement Trends: OIG Report Suggests that Urine Drug Testing Is Making Labs a Juicy Target Once Again
June 19, 2018
The Office of Inspector General just published its Semiannual Report to Congress (covering Oct. 1, 2017 through March 31, 2018). Here are the key things labs and lab managers need to know about this … [Read more...]
COMPLIANCE
Medicaid Fraud: Enforcement Continues to Trend Down as Labs Drift Deeper into the Background
May 22, 2018
Last month, the OIG published its annual summary of Medicaid Fraud Control Unit (MCFU) activity for FY 2017. Here is a summary of the key findings, trends and impact on labs. Background The 50 MCFUs … [Read more...]
COMPLIANCE
Physician Referrals: New Rules Offer Some Stark Law Relief but Not Nearly Enough
April 11, 2018
Like most budget bills, the new federal Bipartisan Budget Act of 2018 includes a number of changes to Medicare fraud and enforcement requirements. One set of changes affects the current physician … [Read more...]
FOCUS ON
New Laws: Very Quietly, Congress Doubles Penalties for Medicare Fraud & Abuse
April 10, 2018
Sneaky may be too strong a word. But what is fair to say is that the new hikes in federal health care fraud violation penalties have flown totally under the radar despite their obvious and immediate … [Read more...]
DRUG TESTING
Part B Reimbursement: OIG Flags $66.3 Million in Improper Urine Specimen Validity Test Payments
March 16, 2018
These are tense times for providers of urine drug tests for Medicare and Medicaid patients. And on Feb. 20, the hot seat got even hotter with the issuance of a new OIG report saying CMS made $66.3 … [Read more...]
FOCUS ON
Anti-Kickback Statute: OIG Eyes Changes to Safe Harbor Rules
February 27, 2018
As it does every year, the OIG is reviewing the federal Anti-Kickback Statute (AKS) current safe harbor rules. The deadline to comment: end of business, Feb. 26. Here's a quick rundown of what's at … [Read more...]
