Medicare Compliance & Reimbursement
HOW RELATED PARTY ISSUES CAN LAND PROVIDERS IN PRISON
When a compensation package is too good to be true. A Missouri rehab operator capped off a long, hard lesson in Medicare compliance July 28, paying $580,000 to resolve False Claims Act charges. According to U.S. Attorney Raymond Gruender, Edward Fann, his company Bistate Rehab Inc., and Long Term Care Providers Inc. will pay the sum to cap off a whistleblower suit. But the settlement is only the latest chapter in a long enforcement saga. Fann had earlier pleaded guilty to improperly billing Medicare for occupational therapy and physical therapy, billing for excessive compensation, and failing to report two companies as related businesses. He was sentenced to a year in prison. The feds maintained that Fann and his business associate Gary Sanazaro (now deceased), who owned South County Rehabilitation Inc., paid themselves excessive salaries on Medicare's tab by concealing relationships between their companies. The case also involved telling Medicare that services were performed by certified occupational therapists - when in fact the therapists were not certified. South County got slapped with a $2.8 million judgment back in April. Lesson Learned: Make sure you diligently report all related parties with whom you conduct business to Medicare - or face steep consequences.
Medicare Compliance & Reimbursement
- Long-Term Care:
BETTER PAY FOR HIGH-QUALITY CARE?
SNFs must prepare for a proposed link between payment and QI data. If a skilled [...] - HIPAA:
HIPAA, UNPREPARED PROVIDERS COULD CAUSE CLAIMS NIGHTMARES
Some provider groups are predicting a claims "train wreck." Three months before the Health Insurance [...] - Long-TermCare:
WHAT THE 2004 ADJUSTMENTS MEAN FOR NURSING HOMES
Industry braces for much-needed cash infusion. Skilled nursing facilities are in for a significant payment [...] - Medicare Reform:
DISCOUNT CARD AGREEMENT PUTS MOMENTUM BACK IN MEDICARE REFORM NEGOTIATIONS... BUT FOR HOW LONG?
House and Senate Medicare conferees have reached a "tentative agreement" on rules for prescription-drug discount [...] - HealthPlans:
WHY HEALTH PLANS HATE THE IDEA OF MEDICARE 'REGIONS'
The White House, House, and Senate all want to ensure health-plan choices for Medicare beneficiaries [...] - DME:
WHEN IS IT OK TO GIVE A FREE UPGRADE?
It's more often than you might think. Some suppliers might be scared off from furnishing [...] - Rehab:
WHAT'S MISSING FROM THE 2004 IRF PAYMENT UPDATE
Controversial 75 percent rule still unsettled. Inpatient rehabilitation facilities will get a 3.2-percent raise in [...] - Hospitals:
CMS PROPOSES 3.8-PERCENT OPPS UPDATE
Hospital payments under the outpatient prospective payment system would get a 3.8-percent increase under the [...] - Pharmaceuticals:
LOOKING INWARD ON MEDICAID PRICING, REBATES
Sparked by federal scrutiny, drugmakers examine compliance practices. Medicaid rebates and drug pricing issues are [...] - Rehab:
HOW RELATED PARTY ISSUES CAN LAND PROVIDERS IN PRISON
When a compensation package is too good to be true. A Missouri rehab operator capped [...] - Physicians:
PHYSICIAN FACES 'SHOCK' PROBATION
Upcoding leads to weekends behind bars Health care fraud enforcers are using the latest trends [...] - HomeCare:
LAWMAKERS COULD TARGET HOME CARE FOR CUTS
It just may have become more difficult to get negative home care provisions out of [...] - Medicare+Choice:
2 FLORIDA M+COS BUSTED FOR MARKETING VIOLATIONS
As the competition to enroll Florida seniors in Medicare+Choice plans heats up, more health plans [...] - PROGRAM MEMO ROUNDUP
Starting Jan. 1, 2004, patients will have a better sense of what's going on if [...]
