There seems to be a problem-Now what should I do?
Health Care Auditing Strategies, February 1, 2005
This is an excerpt from a member only article. To read the article in its entirety, please login.
It may be the hardest part of an auditor's or compliance officer's job-deciding what to do when there's an instance of wrongdoing.
Whether the nature of the matter is medical or financial-or whether it's based on cost reporting, claims filing, documentation, licensure, or certification-each situation requires nuanced analysis.
General rules for next steps are not always easy, says Donna K. Thiel, Esq., a partner in the Food and Drug Administration/healthcare regulation practice at Latham and Watkins in Washington, DC.
"In general, you are not going to shoot a mouse with an elephant gun. If the problem is small and isolated, you may just report to the intermediary. If it is potentially a larger problem, you might go to the OIG but not without full understanding of the issue and careful consideration of the consequences," Thiel says.
This is an excerpt from a member only article. To read the article in its entirety, please login.
Related Products
-
Strategies for Health Care Compliance
News and real-life examples to increase the effectiveness of your compliance program. Strategies for Health Care Compliance...
-
Compliance Monitor
This HTML e-mail newsletter delivers news on Medicare and Medicaid fraud and abuse, as well as recent documents and targets...
-
Medicare Weekly Update
Each issue of Medicare Weekly Update includes the latest CMS proposed and final rules, CMS manual revisions, and...
-
Medicare Update for Physician Services
Medicare Update for Physician Services is a free, monthly e-zine that delivers news and information to help physician...
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- HIPAA Q&A: Level of encryption needed for email
- Topic: CMS, OESS post new security compliance review information, checklist
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- CMS has reformulated payments for some bilateral procedures
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Follow CMS' coding guidelines when using modifier -25
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- Cohesive History and Physical Requirements
- Searched