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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 30, 2008

• Walgreen's pharm techs charged with Medicaid fraud

  Two pharmacy technicians in South Florida were accused of defrauding the Medicaid program out of...

• Home healthcare scheme totals $1.1 million in kickbacks

  Eight owners and employees of several Michigan home healthcare agencies were indicted by a federal...

• Tip: Refer to OIG guidance for compliance program fundamentals

  The OIG’s Supplemental Compliance Program Guidance for Hospitals outlines seven elements of...

Issue 48, December 23, 2008

• OIG concerned about adverse events case study results

  In a case study of adverse incidents among Medicare beneficiaries, the OIG found that 15% of a...

• CMS talks quality in listening session

  CMS held a listening session December 18 regarding hospital-acquired conditions (HACs), never...

• Tip: Engage your audience when conducting compliance training

  When conducting compliance education sessions, plan how you will keep your trainees&rsquo...

Issue 47, December 16, 2008

• Employees fired after snooping in news anchor's medical records

  An Arkansas hospital fired six employees in October for illegally accessing patient medical records.

• Banned DME suppliers continued to collect Medicare money

  In a November report, the OIG said that suppliers of durable medical equipment, prosthetics...

• Tip: Address anti-kick back statutes and Stark Law

  According to the OIG’s Supplemental Compliance Program Guidance for Hospitals, hospitals...

Issue 46, December 9, 2008

• Tip: Conduct regular, focused audits

  The OIG recommends that hospitals conduct regular audits. Either internal or external auditors with...

• CMS proposes NCDs for surgical never events

  CMS proposed three national coverage determinations (NCD) to establish uniform national policies...

• Report says state agency made improper SPMP claims

  The OIG reported that the New Hampshire Office of Medicaid Business and Policy did not submit...

Issue 45, December 2, 2008

• New York medical supply company to pay U.S. millions

  Bayer Healthcare in Tarrytown, NY, agreed to a $97.5 million settlement with the United States over...

• Tip: Audit compliance program to determine effectiveness

  The OIG believes an ongoing evaluation process is critical to a successful compliance program...

• OIG review finds CMS behind on audit recommendations

  During a recent review, the OIG found that during fiscal years 2006 and 2007, CMS resolved 3,462 of...

• Featured Audit Plan: Observation Services

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

Issue 44, November 25, 2008

• Joint Commission offers recommendations for "hospitals of the future"

  The Joint Commission released a report November 20 presenting guidance for hospitals to use in what...

• Tip: Monitor potential risk areas

  Auditing alone is not enough to maintain an effective compliance program—organizations must...

• CMS reports improper FFS payments declining

  CMS reported a decrease in Medicare fee-for-service improper payments, from 3.9 percent in fiscal...

Issue 43, November 18, 2008

• DOJ recovers billions in settlements, judgments in FY2008

  On November 10, the U.S. Department of Justice (DOJ) announced it has recovered more than $1...

• Tip: Create a mission statement for your audit

  Every audit must begin with a clearly stated purpose that drives and defines the entire process...

• Florida man sentenced for selling patient information

  On November 12, Southern Florida United States District Court Judge Marcia Cooke sentenced Melvyn...

Issue 42, November 11, 2008

• Tip: Determine if benefits outweigh risks when it comes to voluntary disclosure

  The balancing of benefits and risks of voluntary disclosure is complex and should be undertaken...

• OIG finds billions in inappropriate DSH payments

  In a review of Medicare capital disproportionate share hospital (DSH) payments, the OIG found that...

• RAC permanent program on standby

  CMS announced Nov. 3 it has delayed the Medicare Recovery Audit Contractor (RAC) permanent program...

Issue 41, November 4, 2008 - VIEW THE FULL ISSUE

• FTC extends deadline for "Red Flags Rule"

  The Federal Trade Commission (FTC) has extended the deadline to implement the “Red Flags...

• Louisiana claims nearly $20M in unallowable costs for Katrina evacuees

  A report from the OIG’s Office of Audit Services (OAS) found the state of Louisiana claimed...

• Tip: Follow the OIG's suggestions for monitoring compliance program

  Auditing alone is not enough to maintain an effective compliance program. Organizations must...

• Tip: Review your procedures for access patient information in an emergency

  Tip: Review your procedures for access patient information in an emergency

• OIG investigates results of South Florida DME supplier appeals

  The OIG identified a weakness in the appeals process for durable medical equipment (DME) suppliers...

• OIG calls CMS out for lack of action in HIPAA enforcement

  The OIG blasted CMS for its limited enforcement of the Health Insurance Portability and...

Issue 40, October 21, 2008

• New Orleans hospital pays over $3M for Medicaid overpayments

  A New Orleans hospital agreed to pay the U.S. and the State of Louisiana $3.3 million after the...

• Miami doctor and nurse convicted in $11 million fraud scheme

  Two Miami clinicians were found guilty for participating in an $11 million HIV/AIDS infusion fraud...

• Tip: Stay involved and informed in your role at your organization?s compliance program

  Your involvement as a compliance officer and/or auditor can help improve your organization’s...

Issue 39, October 14, 2008

• Tip: Use interviews to understand your organization and assess risk

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

• CMS announces RACs, program improvements

  CMS recently announced recovery audit contractor assignments for its permanent RAC program, making...

• CMS increases fraud prevention

  The recovery audit contractor (RAC) program is not CMS’ only effort to fight fraud and abuse...

Issue 38, October 7, 2008

• Featured Audit Plan: Physician Practice

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

• Ask these questions about your compliance program

  An effective auditor acts quickly to interpret new information and educate staff and providers when...

• Work plan lists nine new audits and reviews for hospitals

  The OIG released its 2009 work plan October 1, listing audits and reviews with an emphasis on...

• DOJ nabs 245 defendants in Florida for Medicare fraud in FY2008

  Florida continues to be a hotbed for Medicare fraud. The U.S. Department of Justice (DOJ) announced...

Issue 37, September 30, 2008

• Tip: Develop a work plan post risk assessment

  After you have completed a comprehensive risk assessment of your organization, it is time to take...

• CMS paid billions in questionable claims

  A report from Republicans on the Senate Homeland Security investigations subcommittee sites poor...

• CMS provides updated RAC numbers

  CMS released an updated evaluation of its recovery audit contractor (RAC) program, which shows...

Issue 36, September 23, 2008

• New York hospital settles suit for $88 million, signs CIA

  Staten Island University Hospital (SIUH) agreed to pay more than $88 million to settle claims of...

• Tip: Avoid legal trouble by voluntarily self-disclosing conduct that may present False Claims Act liability.

  Overpayments or other conduct that could result in FCA allegations generally should be investigated...

• Medicare Part B premiums remain the same in 2009

  CMS recently announced its premiums and deductibles for 2009 in a press release on the CMS Web site.

Issue 35, September 16, 2008

• Michigan overpays more than 200,000 families in assistance program

  Michigan’s Temporary Assistance for Needy Families (TANF) program made nearly $24 million in...

• Miami docs plead guilty for fraud at HIV infusion clinic

  On September 11, two Miami physicians pleaded guilty to charges of defrauding the Medicare program...

• Tip: Perform a post-audit evaluation to assess strengths and weaknesses

  After the audit report is issued, the audit team should perform a post-audit evaluation. Its...

Issue 34, September 9, 2008

• Colorado Medicaid failed to implement all OIG recommendations

  Colorado’s Medicaid Drug Rebate Program only partially implemented the recommendations in the...

• New Hampshire ambulance company fined $1M for false claims

  Rockingham Regional Ambulance Inc., based in Nashua, NH, agreed to pay $958,000 to resolve claims...

• Tip: Five ways to prevent would-be whistleblowers

  Tip: Five ways to prevent would-be whistleblowers

Issue 33, September 2, 2008

• Medicare overpays for drugs while generic version is available

  Medicare paid for drugs that had a cheaper generic version because of a time delay in calculating...

• Hospital overstates wage data

  An OIG report shows that in fiscal year 2005, the Ochsner Clinic Foundation, based in New Orleans...

• Tip: How to handle instances of noncompliance

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

• Featured Audit Plan: Compliance Effectiveness

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

Issue 32, August 26, 2008

• OIG: Medicare overstated fraud recoveries

  Medicare allegedly instructed outside auditors ignore government policies designed to accurately...

• Maine Medicaid pays $600,000 in overpayments due to computer error

  The Maine Medicaid program’s malfunctioning computer system caused the program to make over...

• Tip: Using questionnaires

  Tip: Using questionnaires

Issue 31, August 19, 2008

• State Medicaid agencies fail to report inadequate providers to OIG

  An OIG report shows states continually fail to inform the OIG when they prohibit healthcare...

• More providers will stop paying for never events

  Nearly half of the states in the U.S. have urged hospitals to implement a policy not to charge...

• Tip: Six questions to ask when evaluating a hospital's response to detected deficiencies

  If you detect a deficiency in your hospital that could result in a compliance issue, it is...

Issue 30, August 12, 2008

• Stark Law changes effective October 2008

  CMS posted new Stark Law regulations on July 31, revising and expanding the prohibition on...

• California men accused of using homeless for fraud

  Federal authorities arrested two Los Angeles men accused of using homeless people in a Medicare...

• Tip: A four-step planning process for rapid compliance program development

  Incorporate each of these steps into your compliance planning process.

Issue 29, August 5, 2008

• Featured Audit Plan: Physician Practice - Coding

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

• CMS adds more never events to list of uncovered conditions

  CMS officials announced Thursday the addition of two hospital-acquired conditions (HACs) to its...

• New Jersey pays for Medicaid beneficiaries living in New York

  The Office of Inspector General determined that New Jersey paid over $1 million on behalf of...

• Tip: Use Compliance Guidance to help with billing and coding

  Use the OIG’s Compliance Program Guidance for Hospitals to ensure your program is following...

Issue 28, July 22, 2008

• New York DOH claimed $21 million in overpayments for IMD services

    The New York State Department of Health (DOH) improperly claimed over $21 million in Federal...

• Members of Congress request GAO study on RACs program

  Four congressmen and one congresswoman are asking the Government Accountability Office (GAO) to...

• Tip: How to attack risks

  Develop your risk-assessment processes based on your organization’s size and needs. Consider...

• Missouri medical center to pay $60 million to federal government

  A Missouri healthcare system has agreed to pay $60 million in a settlement regarding claims that is...

• Gift cards do not violate Anti-kickback Statute

  The OIG determined providing gift cards for patients who were not satisfied with their hospital...

• Tip: When determining compliance policies and procedures, follow the OIG's guidance for compliance programs

  The OIG’s supplemental guidance for hospitals recommends considering the following questions...

Issue 27, July 15, 2008

• CMS releases results of RAC demonstration

  Recovery Audit Contractors (RACs) corrected more than $1.03 billion in improper Medicare payments...

• Senate holds hearing on Medicare claims from dead physicians

  The U.S. Senate Committee on Homeland Security and Governmental Affairs’ subcommittee on...

• Tip: Six steps to conducting a SOX 404 audit

  If you’re considering performing a Sarbanes-Oxley 404 audit, you need to identify your...

Issue 26, July 8, 2008

• OIG find errors in Medicaid family planning service claims

  In a review of outpatient Medicaid claims for family planning services, the OIG found New Jersey...

• CMS contracts Medicare claims services to EDS subsidiary

  The Centers for Medicare and Medicaid Services (CMS) has awarded a $148 million contract to...

• Tip: Tools to maximize the effectiveness of your audit

  Audits help facilities ensure compliance and find errors that may result in claims denials and...

Issue 25, July 1, 2008

• State claimed ineligible drugs for Medicaid reimbursement

  In fiscal years 2003 and 2004, Missouri claimed $2.09 billion ($1.33 billion in federal share) for...

• OIG releases MFCU annual report for FY 2007

  In the Medicare Fraud Control Units annual report for fiscal year 2007, the OIG found that MFCUs...

• Tip: Use data analysis to identify potential fraud and abuse

  Data analysis is an excellent tool for identifying potential fraud and abuse. Data analysis is the...

• Featured Audit Plan: Physician practice - provider-based entity model

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

Issue 24, June 24, 2008

• Florida clinic owner and physicians charged with HIV/AIDS drug fraud

  A Miami health clinic owner and five physicians were arrested on Thursday on charges of defrauding...

• OIG finds errors in Louisiana hospital cost report

  In a recent report, the OIG found Louisiana-based East Jefferson Hospital did not fully comply with...

• Tip: Nine questions to ask post-audit evaluation

  Use these nine questions to evaluate your next audit

Issue 23, June 17, 2008

• Beneficiaries receive Medicaid benefits in two states

  The Florida Agency for Health Care Administration (state agency) paid approximately $4.1 million...

• New computer system malfunctions, overpayments result

  In January 2005, the Maine Department of Health and Human Services implemented a new computer...

• Tip: Seven guidelines for developing auditing policies and procedures

  These seven guidelines will help you develop effective auditing policies and procedures.

Issue 22, June 10, 2008

• Tip: A four-step planning process for rapid compliance program development

  Develop compliance program infrastructure – Focus on building a “top-down&rdquo...

• New York State Medicaid will no longer reimburse for certain 'never events'

  Starting in October, New York’s state Medicaid program will stop reimbursing hospitals for 14...

• OIG recommends NY refunds for invalid family planning Medicaid claims

  The Office of Inspector General (OIG) concluded New York State received $918,816 in erroneous...

Issue 21, June 3, 2008

• Department of Justice fights healthcare fraud

  The U.S. Department of Justice (DOJ) continues to focus on healthcare fraud enforcement, resulting...

• OIG recommends consistency for Medicare's outlier payments policies

  The Office of Inspector General (OIG) recommended in its Compendium of Unimplemented Office of...

• Featured Audit Plan: Retirement Plan Audit

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

• Tip: Handling noncompliance concerns

  Whether a noncompliance problem is based on cost reporting, claims filing, documentation...

Issue 20, May 27, 2008

• OIG recommends training, repayment in Texas settlement

  From July 2, 2002 to May 31, 2003, Heartland Health Care in Bedford, TX made 50 claims to Medicare...

• OIG OKs nursing program for Medicare eligibility

  St. John’s Riverside Hospital’s nursing education program met Medicare eligibility and...

• Tip: Prioritizing your risk assessment

  Prioritize risks and develop a solid work plan for your facility. Follow these steps during your...

Issue 19, May 20, 2008

• OIG estimates Medicaid payments made by Maryland for D.C. residents

  The OIG estimated that Maryland paid $2 million for Medicaid services provided to beneficiaries...

• Pension segmentation requirements reviewed at a terminated Medicare contractor

  According to an OIG report, the Regence Group overstated the Oregon Medicare segment assets by...

• Featured Audit Plan: Excluded individuals and entities

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

• Tip: Supporting an audit finding

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

Issue 18, May 13, 2008

• Comparison of ASP and AMP for Medicare Part B

  The OIG posted their sixth report comparing average sales prices (ASP) to average manufacturer...

• Review of excessive payments by TrailBlazer Health

  Of the 382 payments of $10,000 or more that TrailBlazer Health Enterprises (TrailBlazer) made to...

• Tip: Testing compliance related to procedural based provisions

  In testing compliance with procedural-based provisions, obtain sufficient evidence to be able to...

• Featured Audit Plan: Excluded individuals and entities

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

Issue 17, May 6, 2008

• North Dakota procedure development incomplete

  A follow-up audit revealed that North Dakota had partially implemented procedures for their...

• California incorrectly paid Arizona Medicaid beneficiaries

  California made Medicaid payments for beneficiaries who should not have been eligible in California...

• Featured Audit Plan: Excluded individuals and entities

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

• Tip: Establish clear audit objectives

  Government auditing standards require that audits include objectives and that he objectives...

Issue 16, April 29, 2008

• Nebraska's Medicaid drug rebate program weaknesses found

  The OIG determined that Nebraska had not corrected all of the weaknesses found in a previous audit...

• Audit reveals overpayments for inpatient services

  According to an OIG report, TrailBlazer Health Enterprises made 147 high-dollar payments ($200,000...

• Featured Audit Plan: Excluded individuals and entities

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

• Why conduct a risk assessment?

  Why bother to conduct a risk assessment? A good risk-assessment process does the following:

Issue 15, April 22, 2008

• Nine additional conditions proposed for list of never events

  Federal health officials last week proposed adding nine conditions, including dangerous blood clots...

• Washington incorporated some, but not all, audit recommendations

  In a follow-up audit of Washington’s Medicaid drug rebate program, the OIG found that, as of...

• Featured Audit Plan: Excluded individuals and entities

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

• Tip: Effectively use samples in your audits

  Choosing an effective population sample is one of the most critical steps in every audit, but it...

Issue 14, April 15, 2008

• Questions raised about discharges in long-term care hospitals

  Short-stay outliers in long-term care hospitals (LTCH) decreased between fiscal year 2003 and FY...

• New York QIO asked to refund $77K

  Island Peer Review Organization, Inc. (IPRO), a Medicare Quality Improvement Organization in New...

• Featured Audit Plan: Excluded individuals and entities

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

• Tip: Design a data collection instrument

  Planning an audit is much like creating a road map. First establish an objective, then identify and...

Issue 13, April 8, 2008

• WellPoint to stop payments for 'never events'

  Mirroring a new policy by CMS and at least four states, health insurer WellPoint will no longer pay...

• Oregon state agency failed to implement all changes

  The Oregon Medicaid Agency enacted some, but not all of the changes recommended by an OIG audit, a...

• DOJ joins whistleblower suit against Cincinnati hospital

  The Department of Justice (DOJ) has joined a whistleblower lawsuit accusing Christ Hospital, The...

• Featured Audit Plan: Excluded individuals and entities

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

• Tip: Develop a sampling plan

  Planning an audit is much like creating a road map. You should first establish an objective, then...

Issue 12, April 1, 2008

• Only one NGS high dollar payment appropriate

  Only one out of 45 high dollar payments made by National Government Services in 2004 and 2005 to...

• Rhode Island asked to refund $4.9M

  The OIG wants the Rhode Island Medicaid agency to refund $4.9 million for Medicaid non-emergency...

• Most CA Medicaid management information system costs allowable

  The majority of California's Medicaid management information system (MMIS) costs were allowable...

• Featured Audit Plan: Excluded individuals and entities

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

• Tip: Identify and select data sources

  Tip: Identify and select data sources

Issue 11, March 25, 2008

• CVS Caremark to pay $36.7M to settle fraud allegations

  CVS Caremark will pay $36.7 million to settle claims it increased Medicare reimbursement by...

• New Jersey health sciences university off probation

  The University of Medicine and Dentistry of New Jersey (UMDNJ), based in Newark, may no longer be...

• Featured Audit Plan: OIG Supplemental Compliance Program Guidance for Hospitals audit

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

• Tip: Establish an objective

  Planning an audit is much like creating a road map. Your first step should be to establish an...

Issue 10, March 18, 2008

• HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative

  HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative

• Follow-up audits in PA, CA yield positive results

  Follow-up audits in Pennsylvania and California found both states implemented all or most of the...

• Ohio QIO costs mostly reasonable

  Of the $7.7 in costs submitted by the Ohio Quality Improvement Organization (QIO) between August 1...

• Washington QIO reports $73,000 in unallowable costs

  The Washington Quality Improvement Organization (QIO) submitted just over $73,000 in unallowable...

• Featured Audit Plan: OIG Supplemental Compliance Program Guidance for Hospitals audit

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

• Survey

  Survey

• Tip: Developing an audit plan

  Tip: Developing an audit plan

Issue 9, March 11, 2008

• Most high-dollar payments by National Government Services not appropriate

  Forty-one of 59 high-dollar payments made by National Government Services to hospitals between 2003...

• Two NJ companies settle Medicare fraud allegations

  Two New Jersey-based companies agreed to million-dollar settlements to resolve allegations they...

• OIG finds problems with DMEPOS compliance in LA County

  Problems with durable medical equipment, prosthetics, orthotics, and suppliers' (DMEPOS) compliance...

• Tip: Using questionnaires

  To obtain information about the risks facing your organization ask department managers and staff to...

Issue 8, March 4, 2008

• RACs discover $371 million in improper Medicare payments

  Recovery Audit Contractors (RACs) uncovered more than $371 million in allegedly improper Medicare...

• Colorado could owe Medicaid $481,000

  The Colorado Department of Health Care Policy and Financing might owe the federal government as...

• Insufficient data sharing leads to overpayments by Kansas, Missouri

  Lack of inter-government dialogue cost the states of Kansas and Missouri some $196,000 total in...

• Follow-up audits find more problems in Missouri, none in Oklahoma

  A follow-up audit of the Missouri Medicaid agency found the agency had not covered all the...

• Featured Audit Plan: OIG Supplemental Compliance Program Guidance for Hospitals audit

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

• Survey

  Could you use a book filled with tips and strategies to help you make the "compliance" pitch to...

• Tip: Organizational independence

  To achieve organizational independence, the audit department or compliance officer should report...

• Physician Provider Audits: The latest tools to analyze risk and benchmark compliance

  Physicians rarely list coding and documentation among their top priorities. Many believe that such...

Issue 7, February 26, 2008

• Nineteen HealthNow high-dollar payments inappropriate

  Of the 268 high-dollar payments that HealthNow New York, Inc. made to providers between 2003-05, 19...

• Virginia Medicaid agency needs additional policy

  The Virginia Medicaid agency should implement a policy to ensure its accounting records reconcile...

• OIG: Kiosks offering screening questionnaires okay

  Kiosks that offer patients free disease state screening questionnaires in physicians' waiting rooms...

• Featured Audit Plan: Stark Physician Self-Referral Law

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

• Survey

  Could you use a book filled with tips and strategies to help you make the "compliance" pitch to...

• Survey

  Could you use a book filled with tips and strategies to help you make the "compliance" pitch to...

• Tip: Differentiate between auditing and monitoring

  Although many healthcare professionals refer to auditing and monitoring interchangeably, these two...

• Physician Provider Audits: The latest tools to analyze risk and benchmark compliance

  Physicians rarely list coding and documentation among their top priorities. Many believe that such...

Issue 6, February 19, 2008

• Medicare potentially overpays Part B claims by $107M

  Medicare may have spent $107 million more than it should have for Part B claims in 2001 and 2002...

• iCare asked to refund $8M to Medicare

  iCare Medical Supply owes Medicare over $8 million because it did not claim reimbursement for test...

• Government collects $2.2B in settlements, judgments in Fiscal Year 2006

  During fiscal year 2006, the federal government won or negotiated approximately $2.2 billion in...

• Pay-Per-View: Compliance partners: Tips to win over the board

  You may have noticed increased attention from the board of directors and compliance board recently...

• Survey

  Could you use a book filled with tips and strategies to help you make the "compliance" pitch to...

• Featured Audit Plan: Stark Physician Self-Referral Law

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

• Tip: Purpose of audit surveys

  The purpose of an audit survey is to identify areas of potential risk and to develop audit work to...

• Crafting a compliance program that falls just short of tired-and-true? Need new tools to refresh your compliance program and your career? Tell us about it.

  HCPro Inc., wants to know what we can do to help you wake up your facility's compliance efforts.

Issue 5, February 12, 2008

• NJ Medicaid contingency fees deemed improper

  The state of New Jersey improperly claimed nearly $16 million in Medicaid contingency fees for work...

• OIG: Illinois, Indiana Medicaid agencies paid benefits for other state's residents

  Lack of inter-government dialogue cost the states of Illinois and Indiana some $600,000 total in...

• Pay-Per-View: IPPS changes affect hospital compliance, reimbursement

  CMS implemented new hospital inpatient prospective payment system (IPPS) rules in October 2007 in...

• Featured Audit Plan: Stark Physician Self-Referral Law

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

• Tip: Monitoring programs

  Establishing benchmarks is a key component of any monitoring program. Once each benchmark is set...

• Crafting a compliance program that falls just short of tired-and-true? Need new tools to refresh your compliance program and your career? Tell us about it.

  HCPro Inc., wants to know what we can do to help you wake up your facility's compliance efforts.

Issue 4, January 29, 2008

• OIG reviews Medicaid outpatient drug expenditures in Montana

  A small percentage of Medicaid outpatient drug expenditures in Montana for fiscal years 2002...

• Washington state hospitals won't charge for 'never events'

  Washington state hospitals won't charge for 'never events'

• Pennsylvania Medicaid won't pay hospitals for preventable errors

  Pennsylvania hospitals that treat low-income Medicaid patients covered under fee-for-service...

• OIG posts advisory opinion about patient assistance program

  A specific program that arranges for drug donations to free clinics need not worry about Social...

• Pay-Per-View: CMS continues to concentrate on physical therapy community

  During the past few years, CMS peppered the physical therapy community with transmittals designed...

• Pay-Per-View: Audit cath labs effectively

  There's a lot riding on the accuracy of cardiac catheterization laboratory (cath lab) billing and...

• Featured Audit Plan: Physician Contracting

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

• Featured Audit Plan: Physician Contracting

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

• Tip: Follow through with your compliance New Year's resolutions

  Popular opinion suggests half of all Americans make resolutions during the New Year. But half of...

• Tip: Determine criteria for an audit

  Tip: Determine criteria for an audit

Issue 3, January 22, 2008

• Tip: Train physicians for E/M missteps

  The risk of HIPAA violations is pervasive and basic at any healthcare institution. People are...

• Pay-Per-View: CMS continues to concentrate on physical therapy community

  During the past few years, CMS peppered the physical therapy community with transmittals designed...

• Pinnacle high-dollar payments in four states generally appropriate

  A total of 235 of Pinnacle Business Solutions, Inc.'s (Pinnacle) 265 high-dollar Medicare payments...

• OIG posts audit of Group Health Incorporated high dollar payments

  Eleven of the 14 high-dollar Medicare payments made by Group Health Incorporated (GHI) to Part B...

• OIG reviews relationship between Medicare Part D payments and drug acquisition costs

  Medicare Part D payment, not including the dispensing fee, exceeded community pharmacies' drug...

Issue 2, January 15, 2008

• Tip: Avoid these EMTALA risk areas

  The following items often fall through the cracks when conducting Emergency Medical Treatment and...

• Featured Audit Plan: Physician Contracting

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

• Pay-Per-View: The New Year: Complete your compliance resolutions

  Some say the arrival of the New Year offers the opportunity to wash away the mistakes of 2007 and...

• OIG posts follow-up audit of the Medicaid Drug Rebate Program in Kansas

  A follow-up audit of the Medicaid Drug Rebate Program in Kansas found the state had addressed all...

• OIG: Texas physical therapist's Medicare claims do not meet requirements

  An OIG review of a Texas physical therapist's Medicare claims for 2002 found that none of the...

• Physician-owned specialty hospitals not ready for emergencies

  Most physician-owned specialty hospitals are not ready to deal with emergencies, according to a...

Issue 1, January 8, 2008

• Tip: Make use of the OIG Work Plan

  Take a systematic approach to address problems in 2008. Here are the six key steps to ensure that...

• Healthcare Audit Resource Center Audit Plan of the Month

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

• Pay-Per-View: Changes to Phase III Stark regulations arrive to give guidance

  Phase III Stark regulations have arrived without the explosive changes some feared, but they still...

• Georgia asked to repay $2.8M to federal government

  Georgia's Medicaid agency inappropriately claimed federal financial participation (FFP) for...

• OIG releases audit of Missouri Medicaid disproportionate share hospital payments

  Missouri correctly determined seven state-owned Institutions for Mental Diseases (IMD) were...

Issue 1, November 11, 2008

• Featured Audit Plan: Advance Beneficiary Notice practices

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