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

Compliance Blog

By AIS Staff - July 15, 2014
The scandal at the Department of Veterans Affairs (VA) that has so outraged the nation over veterans’ access to medical care also has pointed the spotlight on whistleblowers and a covered entity’s compliance with whistleblower protection laws. This month’s issue of Report on Patient Privacy (RPP)...
By AIS Staff - June 16, 2014
Let’s say, for whatever reason, you wanted an electronic copy of your medical records. You have a right to them, by law, except that’s not what’s happening at many HIPAA covered entities. For its June issue, Report on Patient Privacy (RPP) took a look at the websites of several prominent health...
By Nina Youngstrom - March 10, 2014
Two recovery audit contractors have a bone to pick with some of the changes planned by CMS for the next round of the five-year RAC contracts and have filed “pre-award” protests with the Government Accountability Office (GAO), Emily Evans, a partner in Obsidian Research Group in Nashville, said at a...

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