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 Panacea Healthcare Solutions. 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
From Report on Medicare Compliance - A federal judge on May 8 ordered Halifax Hospital Medical Center to turn over a legal memo on physician compensation to the Department of Justice (DOJ) and its whistleblower, saying it was not protected by attorney-client privilege because of the crime-fraud exception. The exception voids privilege when a client is engaged in or is about to engage in criminal or fraudulent conduct, and the attorney’s advice is used to further… Read more
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