Claims Processing Ongoing Monitoring and Auditing: Improves Revenue and Prevents Costly Errors
The Medicare administrative contractors (MACs) continue to question claims. The zone program integrity contractors (ZPICs) seek pattern errors suggesting fraud…
Tips on Developing Compliance Policies and Procedures
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued a number of compliance program…
The WellCare Investigation Saga Is Coming to a Close
One of the major enforcement sagas in managed care came to a head on May 19th, when Todd S. Farha, former chief executive officer…
Interstate Medical Licensure Effort Advances
It was reported in HealthLeaders Media on September 17, 2014[1] that at least 15 states are considering a revised draft…
Medicare Advantage Organizations Were Improperly Paid Millions of Dollars for Unlawfully Present Aliens
The Office of Inspector General (OIG) is conducting a series of reviews examining Medicare payments made on behalf of individuals who are…
A Primer on CMS-Regulated Accountable Care Organizations
The Centers for Medicare & Medicaid Services (CMS) defines an Accountable Care Organization (ACO) as a group of doctors, hospitals,…
2014 Second Quarter OIG Enforcement Actions Against Organizations That Hire Excluded Individuals
The Department of Health and Human Services Office of Inspector General (OIG) reported during the second quarter of 2014, two…
Developing and Operating a Hotline: What You Need to Know
A hotline is a critical part of any effective compliance program. It is an important avenue of communication between employees…
Make Your Compliance Hotline More Effective: Here Is How
A key component of an effective compliance program is having an effective hotline program. The operative word is “effective.” Many…
Whistleblowers Benefit From Lack of Reporting Channels
The Centers for Medicare & Medicaid Services (CMS), plan to increase the reward for a successful tip about Medicare fraud…
How Important is Anonymity With Hotline Calls?
Organizations must encourage employees to report anonymously to the compliance hotline. At first this may seem like a counter intuitive…
Billing monitoring: Weakest link or greatest strength?
It is well known from the various compliance program guidance documents issued by the Department of Health and Human Services…