From Report on Medicare Compliance - A federal district court in North Carolina on March 18 declined to compel HHS administrative law judges to comply with their statutory 90-day deadline to rule on appeals of claim denials. It granted a motion by HHS to throw out a case filed by Cumberland County Hospital System, doing business as Cape Fear Valley Health System, which sued over the delay at the Office of Medicare Hearings and Appeals (OMHA) in hearing its appeals of $12.3 million worth of claim denials. It often takes 24 months to get on the ALJ’s docket. Read more
From Report on Medicare Compliance - An anonymous letter sent to the compliance officer at Memorial Hermann, a health system in Houston, led to the arrest of a manager in an alleged $9 million, 14-year embezzlement scheme. The case underscores the value of ensuring that employees know how to contact the compliance officer and use the hotline. Kenneth Joseph Wild II, 49, was accused of mail fraud and wire fraud in connection with the submission of phony… Read more
From Report on Medicare Compliance - CMS is stripping more providers of their Medicare billing privileges, sometimes using new grounds from a Dec. 5 regulation, attorneys say. The revocation of billing privileges is so threatening to providers since, obviously, they can’t bill for services while their privileges have been withdrawn, which continues through their appeal. If the revocation hits practitioners, they also can’t order or provide services at hospitals and their ability to fight back has… Read more
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