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21 Apr 2011, 6:25 am by Todd Rodriguez
We spend a great deal of time on this blog recounting stories of physicians and other providers who have run afoul of the various federal and state abuse laws applicable to the practice of medicine. [read post]
12 Apr 2011, 10:58 am by Todd Rodriguez
Although many Medicare billing rules can present challenges for physicians, the incident-to billing rules consistently confound many physicians. [read post]
31 Mar 2011, 8:52 am by Todd Rodriguez
Several federal agencies have just issued much awaited proposed guidance regarding Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. [read post]
29 Mar 2011, 11:45 am by Todd Rodriguez
Too many physicians still believe that federal and state fraud authorities are only interested in large health systems and pharmaceutical companies. [read post]
28 Mar 2011, 8:03 am by Todd Rodriguez
We’ve known for a while now that the Medicare Recovery Audit Contractors ("RAC") program would eventually start impacting physicians and other Part B providers. [read post]
24 Feb 2011, 2:55 pm by Todd Rodriguez
In case you thought that you didn’t need to pay much attention to complying with the HIPAA Privacy Rule, a Notice of Final Determination issued by the Office of Civil Rights (OCR) of the Department of Health and Human Services this month should get your attention. [read post]
18 Feb 2011, 2:48 pm by Todd Rodriguez
With what is likely to be one of the largest Medicare fraud take downs of its kind, the Federal Bureau of Investigation (FBI) announced yesterday that the Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare Fraud schemes involving more than $225,000,000 in improper billing to the Medicare program. [read post]
31 Jan 2011, 9:10 am by Todd Rodriguez
The Office of Inspector General (OIG) of the Department of Health and Human Services is hosting six free OIG compliance training sessions for local health care providers, compliance professionals, and their legal counsel. [read post]
30 Jan 2011, 9:41 am by Todd Rodriguez
Under a new Pennsylvania law which took effect on January 22, 2011, physicians who bill patients or third party payers for clinical pathology laboratory tests purchased from an independent laboratory are required to disclose on the bill the name of the laboratory from which the service was purchased, the amount paid by the physician to the lab and the physician’s acquisition or processing (e.g., mark-up) charge for the service. [read post]
30 Jan 2011, 9:38 am by Todd Rodriguez
Physicians in Pennsylvania should be aware that a new Pennsylvania law requires physicians and their employees who provide direct patient care to wear a photo identification badge during work hours. [read post]
24 Jan 2011, 1:48 pm by Todd Rodriguez
As proof that no fish is too small for the wide health care fraud nets being cast by government authorities, a Columbus, Ohio internist has pleaded guilty to health care fraud and tax evasion arising out of health care services billed out of his medical practice between 2005 and 2007. [read post]
21 Dec 2010, 12:07 pm by William Maruca
At last, physicians and other professionals and service providers get some relief from proposed identity theft compliance obligations. [read post]
10 Nov 2010, 7:41 am by Todd Rodriguez
The United States Attorney’s Office for the District of Maryland has announced that St. [read post]
9 Nov 2010, 11:20 am by William Maruca
The health reform law (PPACA) requires referring physicians who provide in-office MRI, CT or PET services to inform a patient in writing at the time of the referral that the patient may obtain the service from an alternative source and provide a list of suppliers who furnish the service in the area in which the patient resides. [read post]
9 Nov 2010, 6:21 am by Todd Rodriguez
The final Medicare Physician Fee Schedule for 2011 was placed on display at the Federal Register on November 2 , 2010. [read post]
8 Nov 2010, 1:01 pm by William Maruca
  HHS Secretary Kathleen Sebelius addressed the New York Health Care Fraud Prevention Summit on November 5 in Brooklyn and updated attendees on the government’s efforts to rein in health care fraud. [read post]
8 Nov 2010, 5:26 am by Todd Rodriguez
Two recent Advisory Opinions by the Office of Inspector General (OIG) shed some much needed light of the OIG's view of marketing by health care providers. [read post]
5 Nov 2010, 9:03 am by William Maruca
Responding to input from medical school deans and residency program directors in a recent survey, the OIG has published a plain-English compliance summary for new physicians entitled Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse. [read post]
28 Oct 2010, 6:10 am by Todd Rodriguez
Hot on the heels of the online article in the Wall Street Journal focusing on questionable physician billing practices and Medicare's Carrier Standard Analytic File database, another recent online Wall Street Journal article is now questioning the propriety of physician involvement in setting the relative values used to establish Medicare physician fees. [read post]
26 Oct 2010, 10:03 am by Todd Rodriguez
The recently enacted health reform law has ignited a great deal of public interest in rising health care costs and the underlying reasons for them. [read post]