Tag: Fraud and Abuse

WASHINGTON – The majority of Medicare beneficiaries (84%) received telehealth services only from providers with whom they had an established relationship, the Office of Inspector General has found. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship compared to beneficiaries in Medicare Advantage, it found. “This pattern persisted among virtually all of the most common telehealth services,” the...

WASHINGTON – Rep. Mike Thompson, D-Calif., has reintroduced the Medicare O&P Patient-Centered Care Act to improve access to care and combat fraud and abuse.  The legislation would create separate statutory requirements for the provision of orthoses and prostheses, distinguishing O&P practitioners from other DME suppliers. It would also restore the term “minimal self-adjustment” to more clearly define off-the-shelf orthoses; and prohibit...

WASHINGTON - The Department of Health and Human Services and the Department of Justice have released their “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2016.”The DME-related items in the report include:In March 2016, Respironics paid $34 million to resolve civil False Claims Act allegations for paying kickbacks to DME suppliers to induce those suppliers to buy the company's masks that treat sleep apnea.In April 2016, Hollister and Byram Healthcare Centers...

WASHINGTON - Senior Medicare Patrol projects report $2.5 million in expected recoveries for Medicare in 2015, compared to $660,829 in 2014, a 282% increase, according to a June 3 report from the Office of Inspector General. These projects did not report any expected recoveries for Medicaid in 2015, compared to $504 in 2014. The Senior Medicare Patrol projects also reported $35,059 in savings to Medicare beneficiaries and others in 2015, compared to $80,228 in 2014, a 56% decrease. These projects...

On March 1, 2016, CMS published a proposed rule that seeks to address a growing number of abuses of the federal healthcare program by certain Medicare providers. The rule* titled “Medicare, Medicaid, and Children's Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process” includes a number of provisions that directly concern providers and suppliers of Medicare. These include an increase in requirements for disclosure of affiliations by providers, greater...

WASHINGTON - HME providers who want to do business with Medicare will have to navigate through another layer of bureaucracy starting some time this year.CMS will begin phasing in fingerprint-based background checks for HME and home health providers in 2014, the agency announced in a MLN Matters article published this week.“Apart from the inconvenience of being fingerprinted, think of all the new opportunities for mistakes and delays from CMS and this new contractor,” said healthcare attorney...

WASHINGTON - When it comes to improper payments for orthotics and prosthetic (O&P) services, CMS is going after the wrong guy, according to a new report.Instead of focusing its attention on reducing the number of improper payments going to unlicensed providers, CMS has “engaged in an overkill regulatory assault on legitimate licensed providers,” states a press release from the American Orthotic and Prosthetic Association (AOPA) hailing the report.Two-thirds of the $3.62 billion that CMS...

A few weeks ago, a provider tipped me off that CMS had started recouping payments for Medicare beneficiaries who were in prison at the time of dates of service. This provider was dumbfounded: How could these beneficiaries be in prison when they had received equipment and services in their home and signed delivery tickets, he wanted to know. “This goes to a new low in my eyes,” the provider said. I hadn't heard of this type of recoupment from other providers, so I saved his email to my...

.!. Videodrome divx Dante's Peak film Wimbledon psp Making good on a promise made last year, Sens. Mel Martinex, R-Fla., and John Cornyn, R-Tex., re-introduced the STOP Act this week. The Seniors and Taxpayers Obligation Protection Act, S. 975, targets Medicare waste, fraud and abuse. AAHomecare pointed out in a release that many of the measures outlined in the bill mirror the association's 13-point plan for stopping fraud and abuse. Those measures include pre-enrollment visits and unannounced...