Category: Blog

Part Two: Why You Need to Check Your State and Federal Exclusion Lists

Part Two: Why You Need to Check Your State and Federal Exclusion Lists

March 02, 2023

As mentioned in a previous article, an individual or entity can be excluded from participating in Federal health care programs for a variety of reasons.  The individual/entity will receive notification from the OIG indicating the period of time for which they are going to be excluded. 

False Claims Allegations

False Claims Allegations

03/01/23

James Luketich, MD and associated entities have agreed to pay $8.5M and initiate a Corrective Action Plan to settle False Claims allegations that Dr. Luketich “regularly performed as many as three, complex surgical procedures at the same time, failed to participate in all of the “key and critical” portions of his surgeries, and forced his patients to endure hours of medically unnecessary anesthesia time, as he moved between operating rooms and attended to other patients or matters.” 

Why do you need to check your state and Federal exclusion lists?

Why do you need to check your state and Federal exclusion lists?

02/28/23

In January 2023, the Office of the Inspector General (OIG) collected over half-a-million dollars in Civil Monetary Penalties (CMP) from three health care organizations that employed individuals who were excluded from participating in any Federal health care program.

Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap

Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap

02/14/23

On February 9, 2023, the Department of Health and Human Services (HHS) released a Fact Sheet providing a Public Health Emergency (PHE) Transition Roadmap.  DHHS Secretary Xavier Becerra confirmed that the PHE would end on May 11, 2023.  Below are a few items from the Fact Sheet.  Access this link to view the Fact Sheet in entirety:  https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

Breaking News: PHE to end May 11, 2023

Breaking News: PHE to end May 11, 2023

02/01/23

On Monday, January 30, 2023, President Joe Biden announced that the public health emergency (PHE) will end on May 11, 2023.   There will be many changes as a result of the PHE ending.  One in particular will be the delivery, coding and billing of telehealth services.  CMS had expanded telehealth benefits temporarily during the PHE through the Corona Virus Waiver 1135.  There is a 151-day transition period, after the end of the PHE, for the required changes to take place.

MA Health Plans to Expand Access to Virtual Behavioral Healthcare

MA Health Plans to Expand Access to Virtual Behavioral Healthcare

01/19/23

The need for access to additional behavioral health services is a known issue.  Tele-behavioral health has become one of the go-to solutions in responding to the access issue.  Recently, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, Point32Health, announced a partnership with Valera Health to provide increased access to their patients.  “Valera Health provides adult and pediatric behavioral health patients access to therapists and psychiatrists through telehealth. The organization covers 37 million Americans through partnerships with more than 20 health plans, including Medicaid, Medicare, and commercial plans across several states.”

Are You Performing Periodic Documentation, Coding, and Billing Audits?

Are You Performing Periodic Documentation, Coding, and Billing Audits?

01/11/23

The government continues to actively enforce the False Claims Act [31 U.S.C. §§ 3729-3733] (FCA) which states that “it is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.”  Examples of this include filing claims that are not medically necessary, billing for services not rendered, billing for a service at a higher level than actually performed (upcoding), etc. 

St. Luke’s Health reports data breach

St. Luke’s Health reports data breach

St. Luke’s Health reported a data breach involving almost 17,000 patients, as a result of a hack into a third-party vendor’s email system.  Two employees of the vendor had their email accounts hacked which lead to the breach of personally identifiable information, diagnoses, and other elements of PHI.

It is vital to ensure that third-party vendors who have access to your PHI/PII are fully vetted from a HIPAA Security & Privacy perspective. 

Office Manager for Chicago Medical Practice Sentenced to a Year in Federal Prison for Fraudulently Writing Opioid Prescriptions

Office Manager for Chicago Medical Practice Sentenced to a Year in Federal Prison for Fraudulently Writing Opioid Prescriptions

It is critical for providers to keep strict control of their prescription pads and access into e-prescribing. 

An office manager in Chicago, IL has been sentenced to federal prison for writing over 3,000 fraudulent opioid prescriptions for individuals who were not patients of the provider.  She and her co-conspirator used family and friends, who were not patients nor in need of opioid medications, to take the fraudulent prescriptions to the pharmacy to get filled and then return the drugs to them.  Some of these drugs were later sold throughout Chicago, for profit.

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