The OIG Recommends Additional Monitoring for Medicare Nursing Home Hospitalization Rates.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report analyzing Medicare nursing home…
Nursing Home Provider Settles for $48 Million for Submitting False Therapy Claims.
On November 19, the Department of Justice (DOJ) announced that The Ensign Group Inc., a skilled nursing provider, settled for…
CMS Provides Instructions for Post Payment Patient Status Reviews.
The Centers for Medicare & Medicaid Services (CMS) released instructions relating to the time period that contractors should begin “patient…
OIG Issues Report Scrutinizing Increased Hospital Outlier Payments.
The Department of Health and Human Services Office of Inspector General (OIG) issued a report examining an increase in hospital…
Clinic Owner Receives 15 Year Prison Sentence for her Role in a $77 Million Medicare Fraud Scheme.
The owner of a clinic in Brooklyn that billed Medicare for more than $77 million for services that were medically…
Publication of Four Final Medicare Rules Delayed Due to Government Shutdown
The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the following four final Medicare payment rules, scheduled…
CMS Issues Instructions for Prepayment Review of Claims
The Centers for Medicare & Medicaid Services (CMS) recently issued instructions for Medicare Administrative Contractors (MACs) on random reviews and…
New Interest Rate for Medicare Overpayments and Underpayments
The Centers for Medicare & Medicaid Services (CMS) recently announced new interest rates for Medicare overpayments and underpayments. Effective October…
Former Mental-Health Clinic Therapist Sentenced to 120 Months in Prison for Role in $55 Million Medicare Fraud Scheme.
A former therapist for Biscayne Milieu, a Florida mental-health clinic, was sentenced to prison for 120 months due to his…
Patient Broker Sentenced to 24 Months in Prison for Role in $67 Million Medicare Fraud Scheme.
A patient broker for a psychiatric facility in southern Florida was sentenced to serve 24 months in prison and ordered…
Johnson & Johnson Agrees to Pay More than $2.2 Billion for Off-label Use and Kickbacks.
Johnson & Johnson (J&J) and its subsidiaries have agreed to pay more than $2.2 billion to resolve criminal and civil…
CMS Issues Additional 2-Midnight Rule Guidance and FAQs.
The Centers for Medicare & Medicaid Services (CMS) has issued additional guidance, updated frequently asked questions (FAQs), and information for…