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Healthcare Auditing Weekly

This weekly email newsletter offers health care internal auditors and compliance professionals the latest information on setting up and maintaining an effective auditing program.

2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003

Issue 7, April 14, 2009

• Tip: Ensure your employees know how to report problems

  Prevention is a big part of keeping your organization from facing serious compliance questions. Be...

• Tip: Ensure your employees know how to report problems

  Prevention is a big part of keeping your organization from facing serious compliance questions. Be...

Issue 18, May 12, 2009

• Hacker holds patient health information for ransom

  A Virginia hacker is asking for $10 million in exchange for the safe return of the personal health...

• Tip: Determine risk with walk-through interviews

  One of the best ways to obtain information about the risk exposures facing an organization is to...

• Florida health plan company enters $80 million agreement to avoid fraud charges

  On May 5, Tampa-based WellCare Health Plans, Inc. agreed to enter a deferred prosecution agreement...

Issue 17, May 5, 2009

• NY releases work plan, fraud unit annual report

  The New York State Office of the Medicaid Inspector General (OMIG) released its second annual work...

• CMS proposes historically low inpatient payment increases

  John Commins, for HealthLeaders Media, May 1, 2009 CMS late Friday afternoon announced...

• Tip: How compliance officers can help mend quality crises

  Although compliance professionals don’t directly treat patients, they can do a lot to improve...

Issue 16, April 28, 2009

• OIG Official: Fighting Fraud is Critical to Healthcare Reform

  Office of Inspector General Chief Counsel Lewis Morris stressed to the Senate Finance Committee...

• Quest Diagnostics Agrees to Pay $302 million in False Claims Case

  Quest Diagnostics Inc., and its subsidiary Nichols Institute Diagnostics (NID), entered into a...

• Tip: Address anti-kickback and self-referral concerns

  The hospital should have policies and procedures in place to deal with federal and state...

Issue 15, April 21, 2009

• Part B contractor overstates expenses in CMS cost proposal

  Pinnacle Business Solutions, a Medicare Part B contractor, reported $247,040 in unallowable costs...

• Improper payments for lab services found in eight of 11 states

  Eight of 11 selected states made a combined $3.1 million in potentially improper payments for...

• Tips for supporting an audit finding

  A significant amount of your audit work will consist of obtaining, examining, and evaluating...

Issue 14, April 14, 2009

• Florida men indicted for Medicare fraud in HIV infusion clinics

  On April 7, U.S. Attorney for the Southern District of Florida R. Alexander Acosta unsealed an...

• PA Medicaid agency miscalculates DSH eligibility

  An April 1 OIG report shows that the Pennsylvania Department of Public Welfare, which administers...

Issue 13, April 7, 2009

• Government agency urges citizens to report fraud and abuse

  In a March 30 press release, the U.S. Government Accountability Office (GAO) urged private citizens...

• OIG adds new Web page for Recovery Act funds oversight

  On April 2, the OIG announced it added a Recovery Act Fund Oversight section to its Web site. The...

• Tip: What to do if there is a noncompliance problem

  Deciding what to do when there’s an instance of wrongdoing may be the hardest part of an...

• Featured Audit Plan: Advance Beneficiary Notice

  Looking for a particular audit plan that may help make your job easier? Turn to the “Audit...

Issue 12, March 31, 2009

• Quality of care roundtable report released

  On March 23, the OIG and the Health Care Compliance Association (HCCA) released a report that...

• OIG refines self-disclosure protocol in open letter

  The OIG released an open letter to healthcare providers, on March 24, explaining changes to its...

• Tip: Ensure your clinical trials process is compliant with these auditing steps

  Before you conduct an audit of your facilities clinical trials/research studies billing, you need...

Issue 11, March 24, 2009

• CMS edit fails to catch improper transfer claims

  On March 11, the OIG issued a report, which detailed the results of a review of hospital compliance...

• HIV clinics set up solely for Medicare fraud

  On March 17, a federal jury convicted two physicians and two medical assistants in Miami in...

• Tip: Perform documentation audit when reviewing E/M coding

  A thorough understanding of evaluation and management (E/M) coding begins with documentation. If...

Issue 10, March 17, 2009

• State Medicaid Agency publishes self-disclosure guidance

  On March 12, the New York State Office of Medicaid Inspector General (OMIG) released Provider...

• CMS continued Advantage payments after beneficiaries' deaths

  On March 4, the OIG reported CMS made $4.4 million in unallowable payments to Medicare Advantage...

• Tip: Follow these five steps for an effective risk assessment

  A risk assessment allows a practice to take inventory of risk areas and identify current and...

Issue 9, March 10, 2009

• Obama unveils choices for healthcare reform

  President Barack Obama introduced his healthcare reform team Monday, March 2, which includes the...

• Kansas M.D. pays over a million in False Claims settlement

  A Kansas cardiologist and his practice group will pay $1.3 million to the United States to settle...

• Tip: Audit clinical research billing to identify and reduce risk areas

  Not all clinical trials/research studies are created equal. Clinical research studies can very by...

Issue 8, March 3, 2009

• OIG finds overpayments in Indiana Medicaid agency

  The Office of Medicaid Policy and Planning in Indiana made more than half a million dollars in...

• Doctor pleads guilty to 'subdosing' AIDS patients

  A California doctor pleaded guilty to federal fraud charges of “subdosing” patients by...

• Featured Audit Plan: Medical Screening Examination

  Looking for a particular audit plan that may help make your job easier? Turn to the “Audit...

• Tip: Use monitoring tool to facilitate by-department reviews

  The monitoring tool is perhaps the most important document in your compliance-monitoring toolkit...

Issue 7, February 24, 2009

• California hospital pays $50K for EMTALA violation

  On January 30, Administrative Law Judge Steven T. Kessel imposed the maximum civil monetary penalty...

• Three RI healthcare professionals disciplined in wrong-site surgery case

  The Rhode Island Department of Health Board of Medical Licensure and Discipline reprimanded three...

• Tip: Make sure cardiac rehab billing lines up with Medicare requirements

  The OIG recommended the following controls to ensure that all allowable cardiac services are billed...

Issue 6, February 17, 2009

• Medicare pays over $33 million in invalid supply and equipment claims

  Medicare allowed over $33 million in payments for medical equipment and supplies claims submitted...

• CMS calls for proper use of modifier - 79

  On February 13, CMS released a transmittal asking contractors to strengthen safeguards that prevent...

• Tip: Seven steps to establish by-department monitoring

  While there is no right or wrong way to set up a compliance-monitoring program, we have created a...

Issue 5, February 3, 2009

• Featured Audit Plan: Medical Necessity Monitoring

  Looking for a particular audit plan that may help make your job easier? Turn to the "Audit...

• NY requires compliance programs for Medicaid providers

  New York Medicaid providers must implement a compliance program according to a new mandate from the...

• Medicare appeals process improving

  The Office of Medicare Hearings and Appeals (OMHA) has improved its decision-making time and...

• Tip: Assess risk, know organization through interviews

  When assessing risk, it’s crucial to have a solid understanding of your organization, the...

• Medicare, Medicaid mistakenly pay for same services

  The OIG recently discovered that in 2005, five state Medicaid programs made $3.3 million in...

• Kansas brings in record Medicaid recoveries

  Kansas’s Medicaid program recovered more than $17 million in 2008 from multi-state litigation...

• Tip: Follow these ten steps to identify vulnerabilities before a risk-based audit

  Develop your risk-assessment process based on your organization’s size and needs. To...

Issue 4, January 27, 2009

• Pharma executives excluded from government programs

  Three former executives of Purdue Frederick, a pharmaceutical company that manufacturers and...

• NCDs announced for three 'never events'

  CMS announced national coverage determinations (NCDs) for three preventable errors identified in...

• Tip: Follow EMTALA compliance steps to avoid violations

  It’s important to understand the details of the Emergency Medical Treatment and Active Labor...

Issue 3, January 20, 2009

• OIG releases annual report results

  The OIG released its Annual Performance Report for fiscal year (FY) 2008, recounting the billions...

• Massachusetts Medicaid program recovers record $46.7M in 2008

  The Medicaid Fraud Division of the office of Massachusetts’ Attorney General Martha Coakley...

• Tip: Questions the compliance officer should as the board of directors

  Consider adapting some of the following questions to query the board of directors regarding their...

Issue 2, January 13, 2009

• HCCA survey shows compliance concerns in poor economy

  The sagging economy is causing concern for healthcare compliance and ethics professionals...

• Featured Audit Plan: HIPAA privacy and security compliance assurance plan

  Looking for a particular audit plan that may help make your job easier? Turn to the “Audit...

• OIG highlights biggest compliance challenges for 2009

  Quality of care, Medicaid and the State Children’s Health Insurance Program (SCHIP), as well...

• Tip: Ensure ABN compliance with regular auditing

  Follow these tips to audit the use of advance beneficiary notices (ABNs) in your facility and...

Issue 1, January 6, 2009

• OIG finds ASPs too high for 41 drugs

  The average sales prices (ASP) for 41 drugs exceeded the average manufacturer prices (AMP) by at...

• CMS requires bonds, revokes billing privileges for DMEPOS suppliers

  CMS continues to step up its efforts to combat Medicare fraud by suppliers of durable medical...

• Tip: Assessing internal disciplinary effectiveness

  The OIG’s Supplemental Guidance recommends that hospitals consider the following questions...