On May 12th, the Office of the Inspector General of the Department of Health and Human Services (OIG) issued a proposed rule which would amend the federal civil monetary penalty (CMP) regulations addressing new CMP authorities created under the Affordable Care Act. The revised regulations would allow for civil penalties, assessments, and exclusion from Medicare for :
- Failure to grant OIG timely access to records;
- ordering or prescribing while excluded;
- making false statements, omissions, or misrepresentations in an enrollment application;
- failure to report and return an overpayment; and
- making or using a false record or statement that is material to a false or fraudulent claim.
Comments on the proposed regulations can be submitted up until July 11, 2014. The proposed rule and instructions for submitting comments can be viewed here—> Proposed CMP Regulatory Revisions
For more information on the revisions to the CMP regulations, Fraud and Abuse, Compliance, Medicare Program Integrity initiatives or related issues, please feel free to contact Ari Markenson or any member of our health care practice group for a further discussion.
Posted in Civil Monetary Penalty, Compliance Programs, Fraud and Abuse, Health Care, Health Care Providers, Medicaid, Medicare, OIG, Program Integrity, Proposed Rule, Regulation, Regulatory Compliance
In a recently released MLN Matters (Number: SE1417), CMS announced that it is implementing the enhanced enrollment screening provisions of the Affordable Care Act (ACA) by requiring finger print based background checks for certain so called “high risk” providers. Currently this means that for newly enrolling Durable Medical Equipment, Prosthetic, Orthotic and Supplies (DMEPOS) suppliers and Home Health Agencies, individuals with a 5% or greater ownership interest in the provider or supplier will be subject to criminal background checks based on fingerprint identification. The procedure will also apply to providers that CMS has elevated to the high risk category pursuant to regulations. Affected providers will be notified by their MAC and be given 30 days to comply. The notification will identify contact information for the Fingerprint Based Background Check Contractor (FBBC). Continue reading
Posted in Community Based Care, Compliance Programs, Durable Medical Equipment, Employee Background Checks, Fraud and Abuse, General, Health & Human Services, Health Care, Health Care Providers, Health Reform, Home Health, Medicare, MLN Matters, Participation, Program Integrity, Provider Enrollment - Medicare, Regulation, Regulatory Compliance
On April 9, 2014, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections (OEI) issued a report (OEI-01-12-00390) entitled “Limited Compliance With Medicare’s Home Health Face to Face Documentation Requirements.”
The Center for Medicare and Medicaid Services (“CMS”) requires physicians to physically see and evaluate patients for home health services. The Patient Protection and Affordable Care Act requires the physicians to document this face-to-face visit as a condition of payment. The face-to-face requirement was implemented to help prevent fraud in home health. The idea is that requiring physicians to document the specifics of a face-to-face visit with a Medicare beneficiary will help prevent fraud by ensuring the physician actually saw and assessed the beneficiary before certifying the patient as eligible for home health services. Continue reading
On February 20, 2014, the US Department of Health and Human Services, Departmental Appeals Board upheld CMS’ revocation of the Medicare provider number of a clinic/group practice.
In Advanced Care Medical Center v CMS (Docket No. C-13-1383/Decision No. CR3124), the DAB, Civil Remedies Division upheld CMS’ revocation of Advanced Care’s Medicare provider number.
The matter began with an investigation by the Office of the Inspector General which revealed that Advanced Care entered into a contract with a doctor, allowing him to bill for services under it’s billing number in exchange for a set reimbursement, and the doctor submitted bills under Petitioner’s billing number. Continue reading
Posted in Certification, Community Based Care, Compliance Programs, DAB Decisions, DHHS, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, Medicare, Out-Patient Care, Participation, Physicians, Program Integrity, Provider Enrollment - Medicare, Regulatory Compliance