Author Archives: Janet K. Feldkamp RN BSN LNHA CHC JD

Combined DOJ/HHS Fraud Crackdown in 7 Cities Across the Country Nets 107 Suspects for $452 Million in Fraudulent Billing

On May 2, 2012, the US. Department of Justice and the U.S. Department of Health and Human Services announced that its combined law enforcement agencies, as part of the Medicare Fraud Strikeforce, rounded up 107 suspects for fraudulent Medicare billing.  These 107 suspects are responsible for $452 million dollars of billing in multiple areas of health care including mental health services, and durable medical equipment and supplies.  More than 500 law enforcement agents were involved in the fraud crackdown from FBI, HHS-Office of Inspector General (OIG) and  multiple state Medicaid Fraud Control Units.  Physicians, nurses, suppliers and owners were included in the list of person that were arrested in the raids.  The seven cities where suspects were arrested were included Miami, detroit, Chicago, Houston, Los Angeles, Tampa and Baton Rouge.

These significant fraud enforcement activities represent the new “normal” as Federal and State government agencies combine resources and use very sophisticated data analytics tools aimed at finding and fighting Medicare fraud.

More detailed information is available at the Office of the Inspector General’s website at www.oig.hhs.gov and you can find a press release on the Department of Justice Website here  —> DOJ Pres Release.

For more information on the Medicare Strike Force or regulatory enforcement in general, please feel free to contact Janet Feldkamp or any member of our health care practice group.

OIG Compliance Materials Consolidated on the Web

The Office of the Inspector General (“OIG”) has just consolidated the compliance education materials on their website at Compliance 101.  This section of the OIG’s website consolidates general educational materials, provider compliance videos and audio podcasts and general discussion.  Links to provider education for health care boards and physicians are included.  This can be a valuable resource for health care providers in developing and strengthening their compliance programs.

You can find the consolidated materials here —> OIG Compliance 101

CMS Provides Additional Guidance on Reporting of Suspected Crimes

The Centers for Medicare and Medicaid Services (CMS) has updated its guidance for reporting of suspicious crimes by long term care facilities.  The Survey and  Certification Memo from June 17, 2011 (S&C-11-30-NH) has been updated as of January 20, 2012 with additional definitions and questions and answers.  Guidance was provided for state agencies, ICF/MRs as well as nursing facilities.  For more information you can get a copy of the revised S&C letter here —> S&C 11-30-NH  

Revised Advance Beneficiary Notice Use Now Required

The revised Advance Beneficiary Notice (ABN) form is now required as of January 1, 2012.  The ABN form is provided to Medicare beneficiaries by providers such as skilled nursing facilities, physicians and others when the provider believes that Medicare may not cover and reimburse the services to be provided.  This notice of noncoverage is provided to the beneficiary and the revised notice Form CMS-R-131 can be accessed through the attached link with additional information on its use.  http://www.cms.gov/BNI/02_ABN.asp