Medicare Compliance & Reimbursement

Plus: Senate lacks votes to change Medicare payment structure, but members vow to keep trying. CMS instructs MACs to suss out sham health care operations. A favorite tactic of some Medicare fraudsters is to set up 'dummy' storefront operations that have billing addresses but no real health care going on. The feds are on to this trick, and that's good. But wellmeaning home health providers and suppliers that have moved recently need to take steps to make sure they don't get caught in the dragnet. According to Transmittal 306 from the Centers for Medicare & Medicaid Services, effective Nov. 2, "all providers and suppliers are subject to unannounced site visits prior to receiving Medicare billing privileges or subsequent to receiving Medicare billing privileges." In certain cases, CMS will instruct a Medicare Administrative Contractor (MAC) to make a visit to a medical provider or supplier to determine if it's operational at [...]