ENFORCEMENT

Provider Fined for Not Taking Compliance Measures Required by Its CIA

Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]

CMS

Post-PAMA: Government Report Warns of Medicare Overspending(!) for Lab Tests

As if the deep price cuts inflicted by PAMA weren't infuriating enough, now the US Government Accountability Office (GAO) is claiming that labs may be getting overpaid. In a report issued late … [Read more...]

OVERPAYMENTS

Rural Hospital Lab Outreach or Fraudulent Overreach?

Case: In February 2017, hospital management firm LifeBrite paid $400K to acquire a bankrupt rural outreach hospital in North Carolina with network status in Blue Cross Blue Shield North Carolina (BC). … [Read more...]

OVERPAYMENTS

CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests

As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on Feb. 20 by issuing a new report chiding CMS for making … [Read more...]

COMPLIANCE

OIG Calls on CMS to Do Better at Medicare Collecting Overpayments

The system Medicare uses to detect and recover overpayments isn't working as well as it should be, according to a new OIG report. The Overpayment Collection System CMS relies on special contractors … [Read more...]

OIG REPORT

CMS Dished Out $729.4 Million in Wrongful EHR Incentive Payments & We’re Going to Get that Money Back

Wrongful payments of Electronic Health Records (EHR) incentives are at the focus of two of the month's biggest stories in health care compliance. The first came down on May 31 when the Justice … [Read more...]

WHISTLEBLOWERS

Tool: Model Hotline Allegations Investigation Procedure

The OIG Model Compliance Plan for Clinical Laboratories requires labs to establish mechanisms for not only receiving but promptly investigating internal complaints and reports of potential compliance … [Read more...]

ENFORCEMENT

OIG Targets Sleep Study Tests

If your lab performs sleep studies on Medicare patients, beware. It is now a high-priority target for federal fraud and abuse enforcement. Here is a look at the risk you face and what you can do to … [Read more...]

LEGISLATION

New Laws: Civil Monetary Penalties Get More Expensive—and Easier to Dish Out

One aspect of the Affordable Care Act (ACA) that is not likely to be repealed is the enhancement of penalties for Medicare and Medicaid fraud and abuse. That includes the new Regulation on civil … [Read more...]

ENFORCEMENT

New OIG Rules Make It Easier to Sock Labs with Civil Monetary Penalties

It may be facing repeal but the Affordable Care Act (ACA) is not going down without a squawk. On Dec. 7, the Office of Inspector General (OIG) accomplished a key piece of ACA business by adopting … [Read more...]


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