From Report on Medicare Compliance - Two years after WellSpan Health won 32 appeals of claim denials, its Medicare administrative contractor (MAC) still hasn’t repaid the York, Pa., health system, making it all sort of a Pyrrhic victory. As of January, WellSpan was still working to recover the money, and its tale is typical of the obstacles hospitals face in the Medicare appeals process. “Whenever we win an appeal, we always have to call and say we haven’t been paid back,” says Colleen Dailey, clinical coordinator of defense audits. Read more
From Report on Medicare Compliance - What started as a civil investigation of a hospice company turned into criminal charges against its top executive for allegedly cheating Medicare and obstructing an audit. The U.S. Attorney for the Northern District of Illinois on Jan. 27 accused Seth Gillman, an attorney and part owner of Passages Hospice LLC, of federal health care fraud, alleging the company billed Medicare for medically unnecessary inpatient care for hospice patients, kept patients… Read more
From Report on Patient Privacy - In 2012, hackers downloaded files with protected health information (PHI) for nearly 800,000 Utah residents after a contractor forgot to reactivate a firewall (RPP 6/12, p. 3). A similar deed two years earlier, also involving a non-working firewall, mistakenly exposed the PHI of 17,000 patients treated by Idaho State University to potential misuse, a situation that ultimately cost ISU a $400,000 settlement with the HHS Office for Civil Rights (OCR)… Read more
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