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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.

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Healthcare Auditing Weekly

Issue 49, December 12, 2006

• Tips for preparing your sample selection

  The sample selection process is one of the most significant audit pieces. It shapes the entire...

• Audit: Nebraska claimed duplicate charges

  Not all of Nebraska Department of Health and Human Services, Finance and Support’s claims for...

Issue 47, November 28, 2006

• Interviewing and evaluating auditors

  Hire a new auditor with the same approach you use to audit. By organizing your search, you will...

• OIG to CMS: Improve collection of End Stage Renal Disease quality-of-care data

  A new OIG report recommends that CMS improve collection of clinical performance measures to address...

Issue 46, November 21, 2006

• Follow these steps for effective compliance training

  The training style you choose for your facility should depend on the type of staff your facility...

• Audit: Missouri improperly claimed $1.1 million

  Missouri’s Division of Medical Services followed the wrong procedure when it claimed $3.5...

• OIG posts new corporate integrity agreements

  Six healthcare entities entered into Corporate Integrity Agreements (CIA) with the OIG, the office...

Issue 40, October 17, 2006

• Tips to ease transition to the 2007 DRG changes

  The 2007 IPPS final rule outlines enough DRG changes to make any coder’s or HIM...

• Insurer changes policy on endoscopy incentives

  Blue Cross of California has agreed to discontinue its policy of paying physicians a higher fee for...

Issue 39, October 9, 2006

• How to audit the laboratory department

  Labs are a high-risk area for noncompliance.

• OIG: Physician received $230,000 in Medicare overpayments

  A New Jersey urologist improperly claimed more than $230,000 in Medicare costs, according to a new...

Issue 38, October 3, 2006

• How to establish by-department monitoring

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

• Audit: University overstated wage data by $90 million

  The University of California’s Los Angeles Medical Center did not comply with Medicare...

Issue 37, September 26, 2006

• Best practices for compliance with individual rights

  Whether auditing and monitoring for all privacy rule rights is conducted as a combined activity or...

• OIG unveils 2007 priorities

  The OIG released its fiscal year 2007 Work Plan this week, which establishes its intention to work...

Issue 26, July 4, 2006

• The OIG recommends that the Illinois Department of Healthcare and Family Service

  If ambulance providers succumb to OIG pressure to stop providing medically unnecessary ambulance...

• OIG: Mutual of Omaha should recoup $2.8 million

  Mutual of Omaha is requesting that providers refund $2.8 million in overpayments for high-dollar...

Issue 25, April 25, 2006

• OIG: Insurance company must reduce cost proposals by $4.7 million

  The OIG is recommending that Empire Blue Cross and Blue Shield of Yorktown Heights, NY, and its...

Issue 24, June 20, 2006

• Tip: Support an effective hotline

  Anybody can get a special phone number and claim they have a hotline. You must be able to show that...

• OIG penalizes two more hospitals for incorrect wage index reporting

  The OIG is requesting that two more hospitals submit revised cost reports. That brings the total of...

Issue 23, June 13, 2006

• Tip: Preparing an audit report

  An audit is not complete until the results are reported in writing to the auditee. The written...

• OIG expected recoveries for first half of 2006 total more than $1 billion

  An audit is not complete until the results are reported in writing to the auditee. The written...

Issue 19, May 9, 2006

• OIG continues wage data crackdown

  Citrus Memorial Hospital of Inverness, FL is the latest provider on the OIG's hit list for stating...

Issue 18, May 2, 2006

• OIG recommends United Government Services refund $516,303

  Medicare overpaid United Government Services (UGS) in Milwaukee by $516,303 for inpatient...

Issue 17, April 25, 2006

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  Today we continue our discussion of auditing against the OIG's Compliance Program Guidance for...

Issue 16, April 18, 2006 - VIEW THE FULL ISSUE

• OIG: New Jersey hospital overstated wage data by $311,908

  The OIG has determined that Hackettstown (NJ) Regional Medical Center overstated its wage data by...

Issue 15, April 11, 2006

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  Today, we'll continue our discussion of auditing against the OIG's Compliance Program Guidance for...

• OIG continues hunt for errant GME payments

  The OIG continues to audit hospitals for appropriate graduate medical education (GME) Medicare...

Issue 13, March 28, 2006

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  This week, we'll continue our discussion of auditing against the OIG's Compliance Program Guidance...

• OIG: CMS should determine whether $3 million in payments were allowable

  The OIG has recommended in an audit that CMS determine whether $3 million in questionable payments...

Issue 12, March 21, 2006

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  Today we'll continue our discussion of auditing against the OIG's Compliance Program Guidance for...

• OIG: Hospital should resolve $338,490 in questional GME reimbursements

  The OIG has recommended that the University of Iowa Hospitals and Clinics work with CMS to resolve...

Issue 11, March 14, 2006

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  This week, we will continue our discussion of auditing against the OIG's Compliance Program...

• OIG: Hawaii should refund $9,532 related to ancillary services

  The OIG has determined that Hawaii's overpaid nursing facilities for a small number of ancillary...

Issue 10, March 7, 2006

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  This week, we will continue our discussion of auditing against the OIG's Compliance Program...

• OIG: Arkansas should refund $238,928 to the feds

  The OIG is asking Arkansas to repay the federal government $238,928 in Medicaid provider...

Issue 9, February 28, 2006

• Auditing against the OIG Compliance Program Guidance for Hospitals

  This week, we will continue our discussion of auditing against the OIG's Compliance Program...

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  Today we will continue our discussion auditing of against the OIG's Compliance Program Guidance for...

• OIG: Hospital should refund $15,759

  The OIG is recommending that the University of Louisville Hospital repay $15,759 after the hospital...

Issue 8, February 17, 2006

• Auditing against the OIG Compliance Program Guidance for Hospitals

  Today, we'll continue last week's discussion of verifying compliance officer duties against the OIG...

• Auditing against the OIG Compliance Program Guidance for Hospitals

  Today, we'll continue last week's discussion of verifying compliance officer duties against the OIG...

• OIG: Kansas should refund $13.9 million

  The OIG has recommended that Kansas refund $13.9 million to the federal government to repay...

Issue 5, January 31, 2006

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week, we'll continue our discussion of auditing against the OIG's Compliance Program Guidance...

• OIG: Fallon Community Health Plan received an extra $154,970 in MMA funding

  The OIG has found that Fallon Community Health Plan of Worcester, MA received $154,970 more than it...

Issue 4, January 24, 2006

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week, we'll outline strategies for auditing procedures related to credit balances as part of...

• OIG: Vermont should refund $323,367 claimed for family planning services

  The OIG has recommended that the state of Vermont refund $323,367 it received in improper claims...

Issue 3, January 17, 2006

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  Today, we'll continue our discussion of auditing against the OIG’s Compliance Program...

• Massachusetts used incorrect methodology to calculate UPL

  The OIG has found that Massachusetts' methodology for calculating the upper payment limit (UPL) for...

Issue 2, January 10, 2006

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  Today, we'll continue instructions for auditing against the OIG’s Compliance Program Guidance...

• OIG: CMS overpaid $5.9 million for interrupted rehab stays

  The OIG has recommended that CMS direct its fiscal intermediaries to recover $5.9 million in...

Issue 1, January 3, 2006

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  Today, we'll continue instructions for auditing against the OIG’s Compliance Program Guidance...

• OIG: Mutual of Omaha must recover $4,109

  The OIG has recommended that Mutual of Omaha recover $4,109 in overpayments related to inproper...