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Feds Raise Healthcare Penalties Again

If you’re a healthcare provider who takes Medicare or another federal program, take note. We didn’t get a government shutdown, but the budget law from last week more than doubled the civil and criminal penalties you face when the government accuses you of fraud, waste, or abuse. To see for yourself, click the link and scroll all Read More

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When the Doctor Is Not In

Last week, it was the California Medical Board, but Medicare ain’t playing around either, doc. It will revoke your billing privileges if you submit inaccurate claims, and it will test the accuracy of those claims by mining data about you and your travels. Recently, for example, the government revoked a clinic’s privileges because it determined the doctor who supposedly rendered Read More

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Don’t Keep The Change, Doc

Meaning, don’t just pocket the difference when the government overpays you for healthcare goods or services. Recently, a medical group agreed to pay $450,000 to settle allegations that it refused to return $175,000 in overpayments that it received from federal healthcare programs like Medicare and Medicaid. Here’s the government’s press release. The overpayments at issue tend to happen in medical Read More

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Feds Arrest Hundreds in Healthcare Raids

Last week, the federal government conducted nationwide raids of healthcare providers and facilities based on $1.3 billion in allegedly false billings. In one day, the feds arrested 412 people in a coordinated takedown that netted 115 doctors, nurses, and other licensed professionals. The government also brought legal action to exclude 295 providers—including doctors, nurses, and pharmacists—from further participating in Read More

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When Medicare Says You Can’t Sit With Us

Earlier this year, the U.S. Department of Health and Human Services issued new regulations on its power to exclude healthcare providers and suppliers from participation in a federal healthcare program. The agency excludes some 3,500 people or entities per year. You’ll want to avoid being one of them. Here are some important takeaways. The agency is empowered to cast Read More

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CMS Puts Out New Physician Self-Referral Disclosure Protocol

If you’re a healthcare provider or supplier, take note. Starting June 1, 2017, there is a new process for self-reporting actual or potential violations of the Stark Law to the Centers for Medicare & Medicaid Services. Remember, Stark says that doctors can’t refer certain, designated health services that are payable by Medicare or Medicaid to entities in which they have a financial interest. Read More

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CMS Issues Final “Overpayments” Rule for Medicare Parts A and B

Speaking of healthcare—providers, suppliers, and other stakeholders should take note that, last week, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited final rule for reporting and returning overpayments under Medicare Parts A and B. The rule defines “overpayments” to include any funds you receive or retain that you’re not entitled to after applicable reconciliation. The CMS published its rule for Medicare Read More

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Medicare’s New Fraud Prevention System Begins to Yield Savings

This summer not only marked the 50th anniversary of the birth of our national Medicare and Medicaid programs; it also marked the fourth anniversary of the launch of Medicare’s experiment with predictive analytics, and it delivered some report cards on the system’s third full year of implementation and use. The Fraud Prevention System (FPS), as it’s called, was legislated into Read More

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Another Massive Medicare-Fraud Roundup

In case you missed it, two weeks ago, the federal Medicare Fraud Strike Force announced a nationwide sweep that ensnared 243 people for their alleged participation in fraudulent schemes to bill Medicare over $700 million. The individual cases are not all related, but the coordinated takedown was the largest we’ve seen so far—both in the number of targets and in the Read More

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An Active Forecast for Healthcare Enforcement

Here is a good summary of the state of affairs when it comes to healthcare fraud and compliance. The bottom line is it continues to be a high priority for government. The highlights? Follow the money. For fiscal year 2015, Congress more than doubled the funding of the government’s Health Care Fraud and Abuse Control program to $672 million. The HCFAC, as it were, was created Read More

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