The 2014 OIG Work Plan includes the following:
Policies and Practices. We will determine the impact of subordinate facilities in hospitals billing Medicare as being hospital based (provider based) and the extent to which such facilities meet CMS’s criteria. Context—Provider-based status allows a subordinate facility to bill as part of the main provider. Provider-based status
…
The 2014 OIG Work Plan includes the following:
Quality of Care and Safety. We will determine how hospitals assess medical staff candidates prior to granting initial privileges, including verification of credentials and review of the National Practitioner Databank. Context—Hospitals that participate in Medicare must have an organized medical staff that periodically appraises its members (42
…
Accretive Health recently agreed to settle a Federal Trade Commission (FTC) complaint that stems from a July, 2011 incident in which an Accretive employee’s laptop was stolen from his car. As a medical billing and revenue management services provider, Accretive grants its employees access to “sensitive personal health information” including “patient names, dates of birth,…
The Department of Health and Human Services (HHS) has released a proposed rule that would modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule by allowing health care providers to make certain disclosures to the National Instant Criminal Background Check System (NICS). The NICS aims to keep guns from being sold to those…
The Office of Inspector General (OIG) has amended the Safe Harbor Regulation regarding electronic health record (EHR) items and services. The primary purpose of the amendment is to extend the Safe Harbor, which was scheduled to expire on December 31, 2013, until December 31, 2021.
Obviously, congressional hopes that EHR would be fully implemented by…
A new OIG Advisory Opinion 13-15, the OIG has resurrected the issue of whether awarding exclusive contracts to hospital based providers involves remuneration in exchange for referrals, because it grants the opportunity for access to an income stream.
In the text of OIG Advisory Opinion13-15, the OIG states as follows:
“The OIG has stated
…
In OIG Advisory Opinion No. 13-03, the Office of Inspector General had the opportunity to deal with two issues which have always raised concerns in the past, i.e. pod labs and swapping. It is no surprise that OIG refused to issue a favorable advisory opinion regarding these issues, and one suspects the request was submitted…
The OIG has issued a Special Fraud Alert, dated March 26, 2013, describing specific attributes and practices of Physician Owned Distributorships (PODs) believed to produce substantial fraud and abuse risk and pose dangers to patient safety.
PODs are physician owned entities that derive revenue from selling or arranging for the sale of implantable medical…
OIG Advisory Opinion No. 12-15 has approved an existing arrangement under which a hospital pays physicians a per diem fee for providing on call ER coverage.
Under the arrangement, the hospital pays per diem fees to 130 specialty physicians on staff who provide on-call services, including:
· telephone consultations;
· in-person consultations, as…
EXECUTIVE SUMMARY: QUESTIONABLE BILLING FOR MEDICARE INDEPENDENT DIAGNOSTIC TESTING FACILITY SERVICES
OEI-09-09-00380
WHY WE DID THIS STUDY
Independent Diagnostic Testing Facilities (IDTF), a type of Medicare provider, offer diagnostic services and are independent of physicians’ offices or hospitals. IDTF services have historically been vulnerable to abuse. In 1997, the Office of Inspector General found that…
