New guidance issued by the U.S. Department of Justice (DOJ) highlights the importance of updating corporate compliance programs to satisfy regulatory requirements. The 2020 updates pick up where the 2019 guidance left off in addressing the evaluation metrics for compliance. The key takeaway for 2020 is that companies are encouraged to update and improve compliance programs with the latest in … Continue Reading
THE ABC’S OF THE S.I.U.: What Providers Need to Know
Medical record requests by payors are commonplace for health care providers. Typically, these requests are received by a front desk employee who responds to the inquiry in short order. Yet, not all requests should be treated the same. When a request for documentation is propounded by the “Special Investigation Unit” (S.I.U.) of an insurance company, special care should be exercised … Continue Reading
Medicare Appeals and Audit Waivers Amid the COVID-19 Pandemic
In the event of a national disaster or emergency under the Stafford Act or the National Emergencies Act and a Public Health Emergency Declaration by government officials, the Department of Health and Human Services (HHS) Secretary can temporarily waive certain Medicaid and Medicare criterion, which are commonly referred to as 1135 Waivers. By way of example, 1135 Waivers or … Continue Reading
New Anti-Kickback Law Targets Opioid Crisis
On October 24, 2018, Congress enacted a new anti-kickback law that applies to many commercial health insurance plans, as well as Medicare and Medicaid. The law, known as the “Eliminating Kickbacks in Recovery Act of 2018” (the “Law”), was passed as part of the SUPPORT for Patients and Communities Act, which generally targets the national opioid crisis.
The Law makes … Continue Reading
(Ride)Sharing is Caring
The transportation landscape in America has evolved and these developments are now impacting health care. With about 75 percent of the U.S. population living in a county with access to an on-demand ride-hailing service, many patients are turning to ride-share services, like Uber and Lyft, as a means to obtain their medical care.
The idea of partnering ride-sharing and health … Continue Reading
CMS Provides Advice on Electronic Laboratory Alerts
CMS recently issued an Advisory Opinion suggesting that physicians who refer diagnostic tests reimbursable under Medicare to a laboratory may, under certain circumstances, receive electronic pop-up notifications in the laboratory’s web-based portal alerting the physicians to various potential issues related to the test results. In the Advisory Opinion, CMS considered certain alerts which a laboratory proposed to provide to its … Continue Reading
Proposed New Jersey Regulation would Restrict Pharma Gifts to Prescribers
Gov. Christie’s Administration recently proposed a regulation to curtail the prescription of unnecessary opioid painkillers. Christie, who serves as the Chairman of President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, expressed concern that treatment decisions of all prescribers (including physicians, dentists and advanced practice nurses) are being improperly influenced by pharmaceutical companies. According to Christie’s press release, … Continue Reading
New York man sentenced to 10 years in prison for involvement in $26 million “billing mill”
Earlier this month, a New York man was sentenced to 10 years in prison for allegedly operating a $26 million scheme to defraud Medicare and Medicaid. The defendant allegedly established 6 medical clinics in Brooklyn that paid elderly people to pose as patients and billed Medicare and Medicaid for unnecessary and/or non-existent medical care and equipment. The defendant, who was … Continue Reading
Healthcare Apps: Physicians Should Proceed with Caution
Advancements in healthcare technology continue at an explosive pace and nowhere is this more evident than in the field of mobile healthcare applications. Technology giants such as Apple and Garmin are diving into the wearable healthcare device arena and healthcare app companies are rapidly developing technology to enable devices to transmit healthcare information directly to physicians from these devices. Not … Continue Reading
Office of Inspector General Work Plan Identifies Compliance Areas of Focus for Physicians
Earlier this month, the Office of Inspector General of the Department of Health and Human Services (“OIG”), the agency charged with enforcement of key federal fraud and abuse laws, published its annual Work Plan identifying the areas of compliance concern under the Medicare program on which it will focus its review efforts in the coming year.
While the Work Plan … Continue Reading