Medicare Compliance & Reimbursement

Home in on these potential sources of complaints. If your healthcare organization isn't on top of new federal regs now in effect in the fraud and abuse arena, it could be blindsided by a payment stoppage. Watch out: An Affordable Care Act provision allows the government to withhold Medicare or Medicaid reimbursement "where there's a credible allegation of fraud," says attorney Paula Sanders, with Post & Schell in Harrisburg, Pa. The measure was implemented on March 25. "The provision allows the government to suspend a provider's payments before the provider receives any form of hearing or due process," says attorney Robert  Mrkette Jr., with Gilliland & Markette in Indianapolis, Ind. "This essentially punishes the provider for nothing more than a credible allegation of fraud." The final rule implementing the provision "generally established an outside limit of 18 months for the government to conclude its investigation of the allegation," relays attorney [...]