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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
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2003
Issue 7, April 14, 2009
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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...