Medicare Compliance & Reimbursement
200 PROVIDERS EXCLUDED PER MONTH
Medicaid rebates were at the center of the biggest health care fraud settlement over the last six months, the HHS Office of Inspector General says in its latest Semiannual Report. In the document, a biannual compendium of the agency's activities, the OIG gives prominent place to the $49 million False Claims Act settlement finalized last year with drug giant Pfizer Inc. The settlement resolved allegations that "educational grants" Parke-Davis (acquired by Pfizer in 2000) made to a health plan amounted to discounts that should have been reported to the government and calculated into the company's Medicaid rebates. The resolution highlights the fact that Medicaid rebates - not just average wholesale price pitfalls - are a major compliance hot button for drugmakers. In the report, the OIG also tallied its fraud-fighting stats for the first six months of its fiscal year. Among the results:
Heads up, hospitals: In a second document - the 2003 Red Book, which compiles OIG cost-saving recommendations that haven't yet been implemented - the watchdog agency zeros in on hospital outpatient department services. Its highest-stakes recommendation - worth $1.1 billion a year - is to change Medicare reimbursement rules to equalize payments for outpatient services provided in hospital outpatient departments with those provided in ambulatory surgical centers. Such a move could take a significant bite out of hospitals' outpatient revenue. Lesson Learned: With providers being excluded at such a rapid clip, health care organizations should be sure to do background checks on their employees to ensure that they don't employ excluded individuals to care for Medicare or Medicaid patients. To see the semiannual report, go to http://oig.hhs.gov/publications/docs/semiannual/2003/03SpringSemi.pdf. To see the Red Book, go to http://oig.hhs.gov/publications/docs/redbook/2003 RedBook.pdf.
Medicare Compliance & Reimbursement
- Medicare Private Plans:
PPOs WON'T PROLONG MEDICARE SOLVENCY, SAYS CMS
Adding preferred provider organizations to Medicare, as the White House strongly advocates, won't significantly improve [...] - Pharmaceuticals:
Senate Finance Produces Bipartisan Rx Plan
Senate Finance Committee Chair Chuck Grassley (R-IA) and ranking Democrat Max Baucus (DMT) unveiled a [...] - Hospitals:
CMS ISSUES FINAL OUTLIER RULE
Hospitals will have until Oct. 1, 2003, before their most up-to-date cost data is used [...] - Hospitals:
RECRUITMENT PLAN DRAWS FEDS' IRE
Double-Check Your Physician Relocation Programs The controversial intersection between physician recruitment and Stark and anti-kickback [...] - Pharmaceuticals:
PHARMA ENFORCEMENT REACHES A BOIL
Drug Giant Targeted In Criminal Probe The aggressive health care fraud enforcement team at the [...] - Fraud & Abuse:
200 PROVIDERS EXCLUDED PER MONTH
Medicaid rebates were at the center of the biggest health care fraud settlement over the [...] - Business Arrangements:
RADIOLOGIST-HOSPITAL JV CLEARS ANTI-KICKBACK HURDLES
Other Specialties Could Face Trickier Path The fact that radiologists don't typically order the tests [...] - HIPAA:
KNOW WHEN NOT TO SECURE A BUSINESS ASSOCIATE AGREEMENT
Health care providers and plans may not have as many Health Insurance Portability and Accountability [...] - Long-Term Care:
LTCHs SET FOR 2.5 PERCENT RAISE
So Long, Satellite Bed Restrictions Long-term care hospitals won't have to deal with potential restrictions [...] - Hospice:
JCAHO STAYS ON FOR HOSPICE ACCREDITATION
The Joint Commission on Accreditation of Healthcare Organizations will serve as a national accrediting organization [...] - Reimbursement :
DSH PITFALLS EMERGE IN OIG SCRUTINY
If you've had your disproportionate share hospital payment calculations challenged for including physician practice plan [...] - People
New Face Atop Troubled OIG As exiting HHS Office of Inspector General chief Janet Rehnquist [...] - Bill Watch
The following bills were introduced in the House: H.R. 2323. A bill to amend to [...] - Register Watch
The end-stage renal disease demonstration program, announced by Centers for Medicare & Medicaid Services Administrator [...] - PROGRAM MEMO ROUNDUP
Home health agencies in Connecticut and Massachusetts may be in line for a paperwork break [...]
