News

We read recently of a radiation therapy provider that agreed to pay more than $3.5 million in a CMP (civil monetary penalty) settlement with the OIG (Office of Inspector General).

According to the settlement, the company submitted claims for radiation and oncology services that:

• Used incorrect CPT codes and service dates
• Weren’t provided
• Didn’t include sufficient documentation to support service necessity
• Were “unbundled”
• Contained “incomplete documentation”

In general, the AMA says, medical billing errors fall into one of two broad categories: fraud or abuse.

T

As many readers of our Michigan legal blog know, the Medicare audit appeals process has relatively small timeframes in which providers can object to claims of overpayments.

The good news for a Las Vegas hospital recently audited by the Office of the Inspector General is that its initial timely response to an audit meant that it was able to reduce the amount the OIG wants refunded for Medicare billing errors by $8,914. The reduction followed Sunrise Hospital & Medical Center’s submission of a handful of claims for reprocessing.

The bad news is that the Health and Human Services (HHS) watchdog insists on the return of the remaining portion of what it claims is $23.6 million in overpayments resulting from M

One of the many changes the pandemic has compelled society to make is telehealth. The rapid rise of telehealth in the year-plus of the pandemic has made healthcare services more accessible, helped preserve personal protective equipment, reduced demand on healthcare facilities and helped to keep both patients and providers free of the virus.

Earlier this year, the Deputy Director for the Health and Human Services Office of Inspector General said telehealth isn’t just a matter of convenience for Medicare beneficiaries, it’s also “a matter of safety for many beneficiaries.”

Because many healthcare providers are saying they expect that telehealth will continue after the pandemic – and could even expand – the OIG Deputy Director announ

The Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) recently announced that it will conduct another audit to determine if acute care hospitals are being overpaid by Medicare.

The second round of audits follows up on a September 2020 audit that found that Medicare overpaid acute care hospitals $51.6 million from 2013 to 2016 for outpatient services to beneficiaries who were inpatients at other facilities such as long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities and critical-access hospitals.

The Detroit metro area has three acute care hospitals.

In a press statement,