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…
The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) and the Office of Inspector General have posted a Toolkit consisting of a series of podcast training videos on the following subjects:
· How to Use the Exclusions Database
· How to Report Fraud to the OIG
· OIG’s Self-Disclosure Protocol
· …
Section 6402(a) of the Affordable Care Act established a new Section 1123J(d) of the Social Security Act entitled “Reporting and Returning Overpayments.” This new provision requires a person who has received an overpayment to report and return the overpayment, and to provide written notification for the reason of the overpayment. On February 16, 2012, CMS published the…
As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th…
In OIG Advisory Opinion No. 11-12, a nationally ranked tertiary hospital proposes to establish a telemedicine program for neuro-emergency clinical protocols and consultations for stroke victims and to provide this program without cost to existing affiliated community hospitals. Since a key component of the program would be the provision of hardware, software and communications applications…
CMS has issued a final rule in 42 CFR § 488.438(c)(2), which will be effective January 1, 2012, which states:
· “When CMS determines that a SNF, a dually participating SNF/NF, or an NF-only facility subject to a civil money penalty imposed by CMS self-reports and promptly corrects the non-compliance for which the…
On July 12, 2010 CMS published the proposed rules to implement the 50% Civil Money Penalty (CMP) reductions for nursing homes that self-report compliance violations. The potential for the 50% reductions was enacted by Section 6111 of the Patient Protection and Affordable Care Act (PPACA), and is available under the following conditions:
1. The nursing home…
At the request of several Members of Congress, the Federal Trade Commission is further delaying enforcement of the “Red Flags” Rule through December 31, 2010, while Congress considers legislation that would affect the scope of entities covered by the Rule. Click here to read the announcement.
By Paul Welk
Contributed by Lee Kim, Esquire
The American Medical Association has posted HIPAA Security Rule guidance for physicians. It recommends that electronic protected health information ("ePHI") should be encrypted and suggests that AES technology should be used (as a more secure alternative to RSA technology). Both data at rest (e.g., files which reside on your hard drive…
