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
December 31, 2018
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?
November 23, 2018
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
April 10, 2018
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
October 24, 2017
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
July 10, 2017
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
June 26, 2017
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
January 6, 2017
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
December 29, 2016
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
December 28, 2016
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...]
