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25 Sep 2020, 11:41 am
In the cases we have handled, orders for DME have NOT been issued to a supplier, pharmacy or testing laboratory selected by the patient. [read post]
12 Sep 2020, 11:46 am
A number of sober homes have therefore engaged a licensed physician to serve as the facility’s Medical Director to oversee and order periodic drug screening tests to verify an individual’s compliance with the rules.[6] Drug screening tests (such as a urinalysis) conducted on insured patients are then billed by the testing In addition to engaging a Medical Director, a sober home may also establish a business relationship with a testing laboratory and with other types of… [read post]
28 Aug 2020, 12:15 pm
In Operation Brace Yourself, DME and medical brace manufacturers were alleged to have paid “kickbacks” and “bribes” to doctors and nurse practitioners working with telemedicine companies for exchange for Medicare patient referrals for medically unnecessary braces. [read post]
22 Jun 2020, 6:30 am
The most popular workers compensation abbreviations include: AWW: Average weekly wage – the average earnings of an employee based on a set number of weeks (or months) prior to the injury C: Claimant – the injured employee Clmt: Claimant CMS: Centers for Medicare and Medicaid Services – the federal government agency that oversees the Medicare and Medicaid programs CMS: Claim management system – within context, the computer system used with the claim handling… [read post]
18 May 2020, 8:48 am
In recent years, home health agencies, DME companies, therapy clinics, and laboratories have been targets for fraud investigations through extensive audits. [read post]
31 Mar 2020, 8:38 am
Section 3712, Revising Payment Rates for DME Under Medicare During the Emergency Period: This Section prohibits scheduled payment reductions in Medicare DME during 2020 and the emergency period. [read post]
16 Mar 2020, 1:32 pm
Coronavirus Update – HHS & CMS Guidance, Directives and Waivers with Respect to Telemedicine, Provider Enrollment Regulations, Claim Appeals, the Suspension of Non-Emergency Survey Inspections, Nursing Homes, Home Health Agencies, Dialysis Facilities and DME Suppliers. [read post]
25 Feb 2020, 3:00 pm
Allow Medicare to cover innovative non-DME alternatives to treat and manage diabetes; such items would be subject to competitive bidding and payments would be capped at the rate for their DME counterparts. [read post]
17 Feb 2020, 9:01 am
Nationwide DME Telemedicine Take-Down. [read post]
13 Feb 2020, 11:50 am
During phase one, which begins May 11, 2020, CMS will impose the PA requirement in one state in each of the DME Medicare Administrative Contractor jurisdictions (California, Michigan, Pennsylvania, and Texas). [read post]
7 Feb 2020, 1:26 pm
DME companies receiving funding, free services, or loans from ResMed to inflate the use of ResMed’s medical devices and services is a violation of the Anti-Kickback Statute. [read post]
27 Jan 2020, 5:38 pm
., a manufacturer of durable medical equipment (DME) based in San Diego, California, has agreed to pay more than $37.5 million to resolve alleged False Claims Act violations for paying kickbacks to DME suppliers, sleep labs and other health care providers, the Department of Justice announced today. [read post]
16 Jan 2020, 3:24 pm
Instead, ResMed is alleged to have violated the Anti-Kickback Statute through the following financial arrangements: ResMed provided DME companies with free call center support for their customers; ResMed provided sleep labs and physicians with free equipment, ranging from face masks to diagnostic equipment, as well as free installation and technical support; and, ResMed arranged for and guaranteed no-interest loans for the purchase of ResMed equipment. [read post]
4 Nov 2019, 11:51 am
According to CMS’ press release, home infusion therapy is “the administration of certain types of medication, through a durable medical equipment (DME) pump, in the patient’s home. [read post]
1 Nov 2019, 3:47 pm
The Centers for Medicare & Medicaid Services (CMS) has adopted — with limited changes — its controversial plan to rewrite Medicare pricing rules for new items of durable medical equipment (DME), prosthetics, orthotics and supplies (DMEPOS) as part of its annual DMEPOS policy update for calendar year (CY) 2020. [read post]
16 Oct 2019, 6:47 am
He covered seven important aspects litigators can follow if they have a truck collision client with a brain injury: Getting Before and After WitnessesAlteration of Consciousness WitnessesBuild Up Your Clients Pre-Morbid IntelligenceDocument and Record ComplaintsIsolate the Defense Medical Examinations (DME)NeuroimagingAttack the Malingering Tests ThemselvesTo read Attorney Abraham’s full analysis, you can contact him directly here or you can subscribe online at AAJ’s trucking… [read post]
2 Oct 2019, 11:25 am
The most common causes of a Medicare or Medicaid fraud investigation are: Phantom billing – billing for services that were never performed Submitting a claim for unnecessary medical services or medical equipment Submitting a claim for medical supplies, equipment, or services that were never ordered Submitting a claim of certification for medically unnecessary supplies Submitting a claim of certification for medically unnecessary services, like hospice or home health care Double billing… [read post]
1 Oct 2019, 3:42 am
In addition, Montgomery and Davis took a number of steps to conceal their illegal agreement, including making kickback payments through a nominee, creating and filing false tax documents, and, for Davis, intervening as CEO to prevent the owners of CPS from obtaining their own Medicare DME supplier numbers that would have allowed CPS to bill for its own Medicare DME orders. [read post]
30 Sep 2019, 2:08 pm
If the MAC or DME MAC should have denied a claim or paid the claim at a different amount, the claim is considered to be an improper payment. [read post]
4 Sep 2019, 10:03 am
Beyond improper coding and billing for ineligible services, telemedicine is susceptible to other types of fraud: Kickbacks – A $1.2 billion fraud case resulted in charges against five telemedicine companies that received illegal bribes from DME companies in exchange for referral of Medicare beneficiaries for unnecessary back, shoulder and wrist braces. [read post]
