“Successful compliance programs are adapted to fit the organization and maximize compliance for individual organizations with unique risk profiles.”
Continue readingKey Takeaways from OIG’s Newly Released General Compliance Program Guidance
New, Stronger Evaluation and Management Upcoding Enforcement
“Earlier this year, regulators made the most significant changes to E&M documentation and coding guidelines in over two decades. They’re more complex than ever before, and enforcement actions are increasing.”
Continue readingIncreasing 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.”
Continue readingSignificant 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.”
Continue readingTelehealth 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.”
Continue readingAnti-Kickback Statute Enforcement in Healthcare
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.
Continue readingHealthcare 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.
Continue readingSanctions 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)
Continue readingCritical Care Services Under the Microscope
Complex and billed at a higher rate, OIG added physicians billing for critical care evaluation and management services to the work plan.
Continue reading