Results of 2022 Medicaid Enforcement Efforts
Key Points: The 2023 Compliance Benchmark Survey by SAI360 and Strategic Management found about one in five responding organizations had…
DOJ and Sentencing Commission Guidelines: Road Map to Compliance Effectiveness
The Department of Justice (DOJ) and U.S. Sentencing Commission (USSC) stress that an effective compliance program is one that prevents,…
Medicare Patients Can Appeal Involuntary Move from Inpatient to Observation Status
Latest Court Ruling Hospitalized Medicare beneficiaries who were switched from inpatient to observation status can appeal the move according to…
Regulatory Changes to Stark Law
The Centers for Medicare and Medicaid Services (CMS) announced regulatory changes to the Physician Self-Referral Law (“Stark Law”), which prohibits…
CMS Strengthens Program Integrity through New Enrollment Requirements and Authorities.
The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to strengthen program integrity within the Medicare,…
GAO Report on Data Analytics for Oversight and Law Enforcement
Overview Over the years, the Department of Health and Human Services Office of Inspector General and the Centers for Medicare…
CMS Publishes Annual Adjustments to ALJ Hearings and Judicial Review Threshold Amounts
The Centers for Medicare & Medicaid Services (CMS) recently published the annual adjustments to the amount in controversy (AIC) threshold…
CMS Seeks Comments on Improved Claim Review Demonstration for Home Health Services.
CMS Proposed Pre-Claim Review Demonstration for Home Health Services The Centers for Medicare & Medicaid Services (CMS) recently published an…
CMS and VA Announce Partnership to Address Fraud, Waste, and Abuse.
The Department of Veterans Affairs (VA) and the Centers for Medicare & Medicaid Services (CMS) recently announced a partnership designed…
CMS Issues Instructions for Medicare Contractors on 2-Midnight Rule Lawsuit Settlement Distributions.
The Centers for Medicare and Medicaid Services (CMS) recently issued instructions to Medicare Administrative Contractors (MACs) regarding distribution of settlement…
GAO Reports on Improper Medicare Advantage Payments.
The Government Accountability Office (GAO) recently testified about improper payments made to Medicare Advantage Organizations (MAOs) before Congress. The GAO’s…
CMS Emergency Preparedness Requirements to be Implemented in November 2017.
CMS will implement the final rule regarding emergency preparedness requirements for Medicare and Medicaid Providers and Suppliers (Program Participants) on…