The OIG recently issued a report summarizing HHS' improper payment rates in Fiscal Year 2015. The report found a 12.09% improper payment rate for Medicare fee-for-service claims in FY2015. HHS pointed to two main causes of the improper payments:
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Topics: Compliance Basics, Auditing and Monitoring, Training and Education, medical necessity
The United States Department of Justice recently entered a $500,000 settlement with an Iowa skilled nursing facility, to resolve allegations that the SNF billed the government for improper therapy provided by a third party therapy services contractor.
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Topics: Penalties and Enforcement, PEPPER, Billing and Claims Submission, medical necessity, Therapy
Recent enforcement news added individual executives to the type of parties entering settlements with the government. Headlines typically devoted to organizations and their owners now include employees being held personally liable.
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Topics: Penalties and Enforcement, medical necessity, Culture of Compliance
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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
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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
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
