Time Magazine published an article on January 4 outlining the Federal Government’s increased measures to combat Medicare fraud. The article outlined that although there is not an official figure on the cost of government health program fraud, the National Health Care Anti-Fraud Association estimates that it is at least $60…
Last week President Obama signed legislation that will delay Medicare payment cuts for one more year. The reduction in pay, 25 percent, had been scheduled to begin on January 1, 2011. The American Medical Association strongly advocated for the delay that is longer than the previous five delays over the…
In September the Joint Commission announced that it will begin to accredit patient-centered medical home models for physicians by July 2011. A medical home model is a method to deliver care that is based on the ability to demonstrate evidence-based protocols, self-management education and care coordination with specialists and other…
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA) that help tackle Medicare and Medicaid fraud. According to Peter Budetti, the Director of the new anti-fraud office at CMS, the proposed rules will provide federal authorities…
The Centers for Medicare and Medicaid Services (CMS) recently published a new rule affecting Durable Medical Equipment (DME) providers. The rule, effective September 27, 2010, strengthens Medicare’s standards for marketing and solicitations and expands enrollment requirements for DMEPOS providers. Important highlights from the rule include: – DME providers will be…
The Office of Inspector General (OIG) published two reports targeting inpatient rehabilitation facilities (IRF). Most notable, however, is the CMS response to the OIG reports. The first report reviewed IRF transmission of patient assessment instruments for calendar years (CY) 2006 and 2007. This report showed that IRFs failed to timely…
The OIG recently published a report showing that from 2006 to 2008, Medicare allowed $2.2 million for routine maintenance and servicing of capped rental durable medical equipment (DME) with rental periods. These payments were erroneously made because the Deficit Reduction Act of 2005 (DRA) dramatically limited, if not eliminated, routine…
The Department of Health and Human Services Office of Inspector General (OIG) published a report finding that Medicare contractors overpaid physicians an estimated $13.8 million for services provided during calendar year 2007 with incorrect place of service codes. The OIG report reminded physicians that they must identify the place of…
President Obama signed the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” The law includes a provision that clarifies Medicare’s position for payment of hospital outpatient services provided on either the day of or the three days prior to an inpatient admission. The 3-day…
The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion 10-08 to address the provision of dietitian and social worker services at a freestanding radiation oncology center (Center) at no extra charge to the beneficiaries. The OIG determined that the proposed arrangement would not…