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Increasing Enforcement of Modifier Codes

“Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. This is why selecting appropriate modifier codes is essential for operating and being reimbursed compliantly.”

Significant Upcoding Risks Emerge with Medicare Advantage

Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she said, “Simply put, the financial incentives created by risk adjustment may be driving upcoding in the severity of diagnoses to garner additional payments.”

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Telehealth Enforcement Actions

“It behooves all healthcare compliance professionals to be aware of the fraud, waste and abuse risks associated with telehealth services. This mode of delivery holds great promise. For it to fulfill that promise, non-compliance needs to be rooted out and corrected.”

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Anti-Kickback Statute Enforcement in Healthcare

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The recent surge in healthcare fraud has prompted heightened enforcement of the Anti-Kickback Statute (AKS). Government agencies are cracking down on illegal financial arrangements that jeopardize patient care. This article explores the significance of AKS enforcement, the impact on healthcare providers, and strategies for compliance in an evolving regulatory landscape.

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Healthcare Compliance Risks with Urine Drug Testing Overpayments

Urine drug testing overpayments drove up to $216 million in overpayments to Medicare over five years, according to a recent OIG audit report.

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Sanctions and penalties for hiring excluded individuals in healthcare

Enforcement Actions: Sanctions and penalties for hiring excluded individuals in healthcare. Why is it crucial to avoid the risk of hiring excluded individuals? List of Excluded Individuals/Entities (LEIE)

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Critical Care Services Under the Microscope

Critical Care Evaluation and Management Services (EMS)

Complex and billed at a higher rate, OIG added physicians billing for critical care evaluation and management services to the work plan.

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Two tips for enabling a speak-up culture in your healthcare organization

Open lines of communication healthcare compliance

A speak-up culture is earned. Invest time with colleagues across your healthcare organization. Develop open lines of communication for effective compliance.