Compliance
OIG Extrapolation in Medicare Compliance Review Triples Hospital’s OverpaymentFrom 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
Greater Use of Clinical Validation Puts DRGs at Risk, Turns Queries Upside Down (with: Sample Query for Documented Diagnosis…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
Bard Settlement Provides a ‘Teachable Moment’ on Hospital Conflicts of InterestFrom 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
On the Compliance Bookshelf
Compliance Blog
By Francie Fernald - June 14, 2013
To stay on top of compliance and employee problems, health care organizations need to have a solid set of policies and procedures to respond to any allegations of mischief within the organization. The Office of Inspector General at the Department of Health and Human Services in its compliance...
By Nina Youngstrom - May 20, 2013
With a cacophony of voices coming at them, providers should rely on only that advice backed by a credible written source, whether they are sorting out coding or contemplating a new business deal.
“Make people show you the rule,” Minneapolis attorney David Glaser says. The burden is on a lawyer or...
By Francie Fernald - April 26, 2013
The Center for Medicare and Medicaid Services is taking a cue from the generous whistleblower rewards that have prompted the rapid growth of False Claims Act cases alleging health care fraud and an Internal Revenue Service program designed to motivate individuals to report tax fraud, which has...
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