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By Namas | Published May 17th, 2019 - Last Review/Update May 21st, 2019
An Update on the DHS OIG's Effort to Combat Fraud & Abuse
Every year, the Department of Health and Human Services (DHS) Office of Inspector General (OIG) is required by law to release a report detailing the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such ...
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By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 23rd, 2019
Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020. The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.
Part of the ...
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By Sean M. Weiss & Frank Cohen | Published May 30th, 2018 - Last Review/Update June 4th, 2018
This year (2018), healthcare organizations (Hospitals, Health Systems, and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency. Focusing on "compliance"-only approaches leaves healthcare organizations exposed to areas of liability oftentimes far more than what they could ever imagine or even...
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By Wyn Staheli, ChiroCode Director of Research & Dr. Evan Gwilliam, Clinical Director PayDC Software | Published April 23rd, 2018 - Last Review/Update February 28th, 2019
In August of 2017, a Brooklyn chiropractor was ordered to repay $672,805 to Medicare because the reviewer found that 100% of the claims reviewed (from 2011-2012) did not meet medical necessity requirements. The chiropractor enlisted help from two reputable experts who disputed the findings of Medicare’s Professional Reviewer (MPR). However, the OIG maintained that the findings of the original auditor were valid.
Since none of us have ½ million in cash just laying around, it is essential to learn, understand, and make changes where appropriate to help audit-proof patient documentation.
Read here to learn more.
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By Joan S. Hartman, RHIT | Published January 22nd, 2018 - Last Review/Update January 25th, 2018
Compliance. It is one of the buzz words in healthcare that is heard all the time but what is it really, and why is it so important?
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OIG Advisory Opinion Recinded - Lessons Learned
December 21st, 2017
By Wyn Staheli, Director of Research | Published December 21st, 2017
In the compliance world, it is important to know when the OIG makes an advisory opinion on a subject. For example, the advisory on Time of Service or Prompt Pay Discounts helps to ensure that providers are creating policies and procedures which will meet the standards of the OIG in the case ...
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Summary of OIG Reports for Chiropractic
October 23rd, 2017
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 23rd, 2017
The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ...
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Health Care Fraud - Don’t Do It!
July 31st, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 31st, 2017
If you wonder if what you are doing is fraud, DON’T DO IT! The government takes this extremely serious. I don't need to tell you this.
I have often been apprehensive about making a mistake and I wonder, will it be fraud? Will I spend time in jail for accidentally sending in a duplicate ...
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CMS Overpaid Providers $729 Million in Incentive Payments
June 16th, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published June 16th, 2017
Medicare paid hundreds of millions in electronic health record incentive payments that did not comply with federal requirements according to the OIG. The OIG estimated CMS inappropriately paid $729,424,395 to EPs who did not meet the requirements for meaningful use.
Eligible professional’s (EP’s) are physicians, dentists, podiatrists, optometrists or chiropractors, if ...
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The Office of Inspector General (OIG)
April 14th, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 14th, 2017
The Office of Inspector General (OIG) has the responsibility to identify and detect fraud, waste, and abuse for the United States Department of Health and Human Services (HHS) (also known as the Health Department). The mission of the U.S. Department of Health and Human Services is to enhance and protect ...
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Office of Inspector General (OIG) - Compliance Program Guidance
April 14th, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 14th, 2017
The compliance program guidance documents are listed below.
09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008)
Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000)
11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005)
NSTC Launches Government-Wide Initiative ...
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Another OIG Report on Chiropractic
October 25th, 2016
By ChiroCode | Published October 25th, 2016 - Last Review/Update March 5th, 2019
On October 19 the Office of Inspector General for Health and Human Services (OIG) released another report on chiropractic. Oddly enough the Wall Street Journal had an article on that report published the day it was released (I wonder how that happened). Read hear to see the results.
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OIG adds to increased scrutiny of how patients pay for rising share of drug costs
July 28th, 2016
By | Published July 28th, 2016
Charity programs that help patients pay for the rising cost-sharing obligations of needed drugs may run afoul of anti-kickback rules when the charity’s scope is so narrow that it guides the patient toward specific drugs for treatment or providers, the HHS Office of Inspector General said last week.The OIG’s Supplemental...
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OIG Work Plan to look at excessive patient billing, place of service errors
July 28th, 2016
By | Published July 28th, 2016
The 2014 OIG Work Plan has finally been released and, while it doesn’t have a lot of new issues for physician practices, there are definitely some areas worth your attention to avoid future compliance hassles. If you’ve been wondering where it’s been, the OIG decided to change the timing of...
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OIG Work Plan 2012-Do your own review of these areas
July 28th, 2016
By | Published July 28th, 2016
The Office of Inspector General released its Work Plan for 2012. As in past years, the Work Plan describes the areas of interest that the OIG will investigate in the coming year. There are sections for hospitals, nursing homes, and of course, physicians. There is a pdf file attached to...
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Cloned documentation on OIG radar screen in 2014
July 28th, 2016
By | Published July 28th, 2016
One of the areas where the OIG has its sights set in 2014 is on physician documentation. The OIG plans to review documentation of E/M services looking for what it describes as “documentation vulnerabilities.” Put more specifically, the OIG reports that Medicare Administrative Contractors (MACs) have seen an increase in...
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Chiropractic Listed as Focal Point in 2015 OIG Work Plan
August 19th, 2015
By Brandy Brimhall | Published August 19th, 2015 - Last Review/Update January 30th, 2017
With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses the ...
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Chiropractic Listed as Focal Point in 2015 OIG Work Plan
January 23rd, 2015
By | Published January 23rd, 2015 - Last Review/Update January 30th, 2017
With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses ...
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OIG Reports Success in Efforts to Prevent Fraud, Waste, and Abuse
December 15th, 2014
By | Published December 15th, 2014 - Last Review/Update January 30th, 2017
The HHS OIG Work Plan for the 2015 Fiscal Year has recently been released. In this publication, the OIG addresses the accomplishments made from the previous year's Plan as well as the objectives that will be of interest for the coming new year. Accomplishments for the 2014 Fiscal Year are ...
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Chiropractic is Listed as a Priority in the 2014 OIG Work Plan...Find Out Why
October 16th, 2014
By Brandy Brimhall | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Each year the Office of Inspector General (OIG) issues an updated work plan which outlines the objectives and enforcement priorities for each new year. For Medical providers, including Chiropractic, this information is necessary to review and be familiar with so we may evaluate our own practice systems to ensure compliance ...
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