Breaking Compliance News Blog

$48 Million Enforcement Against Therapy and Nursing Home Company - Lessons We Can Learn

Posted by admin on 12/3/13 12:09 PM

The end of 2013 finds the OIG finishing the year with a flourish in the arena of its skilled nursing enforcements. A company that owns nursing homes and therapy companies recently settled a whistleblower case for $48 million, one of the largest nursing home Medicare recoveries in U.S. history. In the settlement, the company also agreed that each of the six involved facilities would be bound by the terms of a five-year corporate integrity agreement (CIA) with the Office of Inspector General. The CIA and the single, lump sum $48 million payment go toward settling claims of overbilling the government for unnecessary therapy services provided to Medicare patients.

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Topics: Penalties and Enforcement, Billing and Claims Submission, medical necessity, Therapy

Nursing and Therapy - Essential Compliance Allies

Posted by Andrew Buffenbarger on 7/31/13 11:53 AM

Compelling Incentives

We all know that the OIG is increasingly concerned about over-utilization of therapy, and accuracy of care plans. Care plans that are insufficiently documented or overly aggressive, or that are not tailored to the specific resident can lead to false claims - including the over-utilization of therapy services. In order to maximize compliance and avoid penalties related to therapy utilization and care plan accuracy, nursing and therapy must work together.

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Topics: Quality Assurance, Billing and Claims Submission, medical necessity

OIG finds 25% of SNF claims faulty

Posted by Margaret Scavotto, JD, CHC on 11/16/12 3:30 PM

This week, the Office of Inspector General (OIG) released a report: Inappropriate Payments to Skilled Nursing Facilities Cost Medicare More than a Billion Dollars in 2009. The OIG found that 25% of SNF claims submitted in 2009 were in error, amounting to $1.5 billion in overpayments. To read the full report, click here.

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Topics: Compliance Basics, Auditing and Monitoring, Billing and Claims Submission, medical necessity

Compliance program check up: How do you know your billing is accurate?

Posted by Margaret Scavotto, JD, CHC on 6/8/12 2:40 PM

Every health care provider's compliance program should include policies and procedures for complying with the billing requirements of Medicare, Medicaid, and other payors. Undetected billing errors can lead to penalties under the False Claims Act, and/or hefty repayments to the government.
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Topics: Auditing and Monitoring, Billing and Claims Submission

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