From Report on Medicare Compliance - Medicare compliance reviews have turned a corner, with the HHS Office of Inspector General (OIG) using extrapolation for the first time to capture more of the money the hospital presumably owes Medicare. One auditor says this is par for the course in program-integrity audits, but there are different stakes with Medicare compliance reviews, attorneys contend, because hospitals have no direct line to appeal the results and, more specifically, challenge statistical sampling methods. Read more
From Report on Medicare Compliance - Clinical validation is changing the nature of MS-DRG audits, which are eating away at hospital revenue. As Medicare auditors layer clinical validation onto coding validation, diagnoses that affect MS-DRG assignment may not be safe just because the physician documented them. “The bulk of recent audit findings are related to medical necessity, but there is still a lot of money at risk with DRG validation,” says Sandra Routhier, senior healthcare consultant for… Read more
From Report on Medicare Compliance - C.R. Bard Inc. has agreed to pay $48 million to settle false claims allegations over its sale of brachytherapy seeds, a form of radiation therapy for prostate cancer, the Department of Justice said May 13. C.R. Bard allegedly induced hospitals and physicians to buy its seeds by giving them grants, conference fees, marketing assistance and/or free medical equipment between 1998 and 2006 in violation of the anti-kickback law, and then… Read more
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