Medicare Compliance & Reimbursement
LIE TO AN AUDITOR, LINGER IN JAIL
When it comes to dealing with Medicare and Medicaid auditors, a lack of straight talk could lead to a perp walk. Take the case of Dana McGovern, owner of McGovern's Ambulance Service in Calais, ME. McGovern pleaded guilty to 40 fraud and obstruction-related criminal counts after prosecutors accused him of using ambulance run sheets for van transports, counting non-reimbursable destinations (e.g., doctors' offices) as reimbursable destinations (such as hospitals), billing for advanced life support when MAS only supplied basic life support, and other misconduct. When sentencing time came around, the judge slapped him with a steeper sentence based on the fact that he deceived Medicare and Medicaid auditors during an administrative review. On appeal, McGovern tried to counter that rules allowing such sentencing enhancements only apply to criminal investigations - not to routine Medicare/Medicaid audits. The 1st U.S. Circuit Court of Appeals, however, didn't buy it. In U.S. v. McGovern (Nos. 02-2064 & 02-2065), the appellate panel held that lying in health care audits can indeed result in steeper criminal sentences if serious misconduct is uncovered. McGovern now faces more than four years in prison, along with a $729,000 restitution penalty. To see the opinion, go to www.ca1.uscourts.gov/. Lesson Learned: Don't even think about trying to mislead a Medicare auditor.
Medicare Compliance & Reimbursement
- Medicare:
SENATE FINANCE APPROVES
After an all-day June 12 mark-up, the Senate Finance Committee approved a bill that would [...] - Hospitals:
HOSPITALS BRACE FOR NEW OUTLIER POLICIES
Only a small number of hospitals will have to go through the onerous process of [...] - Long-Term Care:
LONG-TERM CARE PROPOSAL COULD PROVIDE SHORT-TERM HELP
But a new CMS SNF payment policy cut both ways.
Skilled nursing facilities would get a [...] - Enforcement :
AN EVEN TOUGHER WHISTLEBLOWER LAW?
A move is afoot to up the stakes yet again in the ongoing campaign against [...] - Ambulance:
KNOW WHO TO BILL WHEN TRANSPORTING HOSPITALIZED PATIENTS
The HHS Office of Inspector General has its eye on ambulance providers who submit Medicaid [...] - Medicare+Choice:
WATERED-DOWN Rx PROPOSAL STILL STRONG ENOUGH TO HELP M+COs
Medicare+Choice plans that have been holding on in hopes of being saved by a prescription [...] - Fraud & Abuse:
LIE TO AN AUDITOR, LINGER IN JAIL
When it comes to dealing with Medicare and Medicaid auditors, a lack of straight talk [...] - People:
GAO LETS LOOSE PARTING BLOW AGAINST EX-OIG CHIEF
The General Accounting Office gave former HHS Office of Inspector General chief Janet Rehnquist a [...] - Quality of Care:
DOLLARS FOR QUALITY
Hospitals could soon collect bonuses from Medicare for delivering high-quality care. The Centers for Medicare [...] - Labs:
SUMMER SURVEYS MAY OFFER SLIMMER CITATIONS
What Will CLIA Inspecions Look Like This Season?
Who says there ain't no cure for the [...] - Pharmaceuticals:
BALDACCI INTRODUCES REVISED MAINE Rx
Maine Governor John Baldacci has proposed a revised version of the state's Maine Rx initiative, [...] - Pharmaceuticals:
WYDEN: NIH IGNORED PATIENT, TAXPAYER COSTS FOR TAXOL
The National Institutes of Health had the authority to get a better deal for taxpayers [...] - Fraud & Abuse:
LIE TO AN AUDITOR, LINGER IN JAIL
When it comes to dealing with Medicare and Medicaid auditors, a lack of straight talk [...] - DME:
PAY A BENEFICIARY, PAY THE PRICE
Mult-million-dollar fraud case keeps DME suppliers in the enforcement cross hairs. Paying patients for their [...] - Bill Watch
The following bills were introduced in the House: H.R. 2423. A bill to amend title [...] - PROGRAM MEMO ROUNDUP
Starting Oct. 1, if you don't include an ICD-9-CM diagnosis code on your Part B [...] - Register Watch
The Centers for Medicare & Medicaid Services asked for comments on extension of two information [...]
