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Medicare Compliance & Reimbursement

HOSPITALS:

New Fraud Hotspots For Hospitals Revealed

Published on Sat Oct 23, 2004

Hospitals should hone in on these key compliance areas.

The HHS Office of Inspector General has released its work plan for 2005 - and it's got a few new bones to pick with Medicare hospitals.

Don't get caught off guard. Here's what you may need to address to be ready when federal investigators come calling this year.

  • Graduate Medical Education. Expect investigators to target alternative payment methodologies for GME for the costs of training residents in non-hospital settings.

  • Post-Acute Care Transfers. Watch out for overpayments involving patients in certain diagnosis-related groups who are discharged from a prospective payment system inpatient hospital and admitted to a post-acute-care setting.

  • Inpatient Rehabilitation Facilities. The OIG says it will zero in on admissions, billing for interrupted stays, outlier payments, patients' length of stay, cost of services and late patient assessments.

  • Long-Term Care Hospitals. High payments and "explosive growth" in LTCs have made this provider group a prime target. Get ready to defend the appropriateness of the level of care provided to patients.

  • Critical Access Hospitals. The OIG says it will examine costs for inpatient and outpatient services both before and after a hospital's conversion to CAH status.

  • Rebates Paid to Hospitals. Are you properly identifying purchase credits as a separate line item in cost reports? The OIG wants to know.

  • Lifetime Reserve Days. Make sure you are adequately notifying beneficiaries.

    To read the work plan, go to http://oig.hhs.gov/w-new.html.

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