Posts tagged with: "durable-medical-equipment-fraud"
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11 Jan 2016, 3:00 am
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule to require Medicare prior authorization (PA) for certain durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) items that the agency characterizes as “frequently subject to unnecessary utilization. [read post]
12 May 2022, 6:59 am
To strengthen state Medicaid program integrity efforts, the OIG is working closely with state auditors, regulators and prosecutors to address improper payments in fee-for-service programs such as hospice, home health and durable medical equipment. [read post]
20 May 2008, 12:48 am
Travelers, 42 A.D. 3rd 277 (2nd Dept.) (2007), the Appellate Division, Second Department upheld the application of a preclusion sanction for a late denial where durable medical equipment supplies were billed for and never provided, so that any amount billed by a health provider for non-existent services must be paid by the insurer when there is a late denial. [read post]
19 Dec 2019, 7:01 am
” Companies are permitted by insurers to bill for “durable medical equipment,” stuff you receive for home use when you’re in the hospital or a doctor’s office. [read post]
3 Feb 2015, 1:47 am
Modify documentation requirement for face-to-face encounters for durable medical equipment (DME), orthotics, prosthetics, and supplies (DMEPOS) to allow certain non-physician practitioners to document the face-to-face encounter (no budget impact). [read post]
11 Jan 2009, 11:58 pm
The fees for services and procedures are governed by the workers compensation fee schedule ( 11 NYCRR 68.1) and durable medical goods fees are governed by the NY Medicaid fee schedule (11 NYCRR part 68). [read post]
21 Jul 2015, 7:50 am
The legislation includes a variety of offsets to pay for new costs, including provisions related to Medicare drug and durable medical equipment payment policy, Medicare imaging reimbursement, and civil monetary penalties in cases of Department of Health and Human Services (HHS) grant or contract fraud, among others (see our related posts on Health Industry Washington Watch). [read post]
3 Dec 2016, 12:00 am
DiNapoli’s auditors also found: · $1,342,307 in overpayments for claims billed with incorrect information pertaining to other health insurance coverage that recipients had; · $937,424 in overpayments for newborn claims that were submitted with incorrect birth weights;· $389,813 in improper payments for inpatient, clinic, durable medical equipment, transportation, and eye care services; · $333,504 in improper payments identified by the… [read post]
30 Jul 2012, 9:29 am
Government Health Care Fraud Fighters Partner With Private Insurers The Federal health care fraud fighting departmental duo of the Departments of Health and Human Services (HHS) Justice (DOJ) last week expanded their network of fraud fighting resources by launching a “ground-breaking” partnership among the federal government, State officials, several leading private health insurance organizations, and other health care anti-fraud groups to prevent… [read post]
20 May 2018, 2:26 pm
The magnitude of the alleged fraud is daunting — the government has estimated the size of the fraud at approximately $240 million. [read post]
4 Mar 2009, 8:59 pm
Providers whose claims might be reviewed include hospitals (acute care, critical access, and long term care hospitals alike), physician practices, nursing homes, home health agencies, durable medical equipment suppliers, and any other provider or supplier that bills for services or equipment under Medicare Parts A or B. [read post]
10 Jul 2024, 2:23 pm
Healthcare Fraud Multi-agency healthcare fraud investigations and prosecutions show that perpetrators of these schemes financially benefited from their fraudulent activities in false billings, mental health, nursing home fraud, chiropractic fraud, durable medical equipment fraud, staged accidents, pharmaceutical diversion, and patient referral (kickbacks) schemes. [read post]
20 May 2009, 9:10 am
Travelers, the Court of Appeals upheld the application of a preclusion sanction for a late denial where durable medical equipment supplies were billed for and never provided, so that any amount billed by a health provider for non-existent services must be paid by the insurer when there is a late denial. [read post]
16 Feb 2018, 5:39 am
An expansion of the durable medical equipment (DME) competitive bidding program to all areas of the country. [read post]
20 May 2018, 2:26 pm
The magnitude of the alleged fraud is daunting — the government has estimated the size of the fraud at approximately $240 million. [read post]
10 Oct 2023, 10:51 am
Rapid Identification of Fraud and Improper Practices. [read post]
23 Oct 2012, 3:52 am
This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. [read post]
10 Oct 2012, 11:49 am
The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. [read post]
23 Feb 2023, 9:01 pm
Finally, MIMF pursued a range of government program and procurement fraud cases. [read post]
25 Feb 2020, 3:00 pm
Expansion of the durable medical equipment (DME), prosthetics, orthotics, and supplies competitive bidding program to all geographic areas and to inhalation drugs, payment of contract suppliers based on their own bids, and elimination of the surety bid bond requirement [$7.73 billion Medicare savings, $435 million in Medicaid savings]. [read post]
