On September 1, 2011, the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS Office of Inspector General (HHS-OIG) jointly announced that eighteen individuals have been charged in the Eastern District of Michigan for their participation in a series of separate Medicare fraud schemes involving home health and […]
In two reports posted August 30, 2011, the Department of Health and Human Services, Office of Inspector General (OIG) announced that many Independent Diagnostic Testing Facilities (IDTFs) in Miami and Los Angeles failed to comply with selected Medicare standards after unannounced site visits in May and June 2010. An IDTF offers diagnostic services and is […]
Statistics recently released by the Transactional Records Access Clearinghouse (TRAC), a Syracuse University Research organization, show a marked increase in federal health care fraud prosecutions. The statistics show 903 federal prosecutions for health care fraud through the first eight months of 2011, compared to 731 such prosecutions for all of 2010. In addition to the […]
In a press release issued August 23, 2011, the Centers for Medicare & Medicaid Services (CMS) invited health care providers to apply to help test and develop four models of bundling payments. CMS has been working with providers to develop models for bundling payments through the Bundled Payments for Care Improvement Initiative. Medicare currently makes […]
A common reason for claim denials through the Comprehensive Error Testing (“CERT”) program and the medical review process is a lack of provider signatures on orders and medical documentation. Medicare requires that services provided and/or ordered be authenticated by the author. The method of authentication must be a handwritten or electronic signature. Stamped signatures are […]
In its over-300-page complaint filed on 8/19/2011, GEICO General Insurance Company, et. al (hereinafter referred to as “GEICO”) asserts that the 32 defendants named in this case–13 physicians, 18 entities, and 1 entity owner– (“Defendants”) defrauded GEICO in an amount in excess of $12.1 million under New York’s No-Fault Insurance law. GEICO also seeks to […]
In a press release issued August 22, 2011, New York State Comptroller, Thomas DiNapoli, announced that New York State stopped or recovered more than $2.3 million in Medicaid overpayments after an audit of the Department of Health’s eMedNY computer payment system. The Comptroller’s Office oversees the financial affairs of New York state agencies, public authorities […]
The Health Information Technology for Economic and Clinical Health Act (“HITECH”) requires the Office of Civil Rights (“OCR”) to conduct periodic audits of covered entities in connection with complying with the privacy and security requirements set forth in Health Insurance Portability and Accountability Act (“HIPAA”). In June, the OCR awarded KPMG, LLP (the “Contractor”) a […]
In a press release issued by the US Department of Justice of the Eastern District of Pennsylvania, a 498-count indictment–240 counts of which involved healthcare fraud–charged 53 defendants, including a physician and pharmacist, in a multi-million dollar drug conspiracy. The press release states that William Stukes–a drug trafficker of Philadelphia–and his alleged drug trafficking organization […]
In an August 1, 2011 letter to the U.S. Department of Health and Human Services Secretary, Kathleen Sebelius, the American Hospital Association (“AHA”) urges the Centers for Medicare and Medicaid Services (“CMS”) to reevaluate its HIPAA Privacy Rule Accounting of Disclosures Proposed Rulemaking (“Proposed Rule”). The AHA is the latest healthcare organization to urge the […]
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