Each year the U.S. Department of Health and Human Services Office of the Inspector General (OIG) produces a work plan that outlines the agency’s focus for the upcoming year. With a staff of over 1,700 professionals, the OIG conducts investigations, audits, and, among other projects, enters and monitors corporate integrity agreements. Below we discuss some of the highlights from the OIG 2013 Work Plan. [...]
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Medicare Claims UpdatesThe Medicare and Medicaid programs provide health insurance for tens of millions of people. According to Centers for Medicare and Medicaid Services (CMS), the Medicare program alone has 47.5 million beneficiaries and, in 2010, had total expenditures of $523 billion. It is not surprising, therefore, that such large programs invite scrutiny from government auditors and their contractors seeking to safeguard the Medicare Trustfund. Below is a brief description of some of the auditing contractors:
Continue reading » In the fall of last year, the Office of Inspector General (OIG) for the Department of Health & Human Services (HHS) released its Fiscal Year 2012 workplan which identifies new and already-in progress programs of focus for the OIG.
Continue reading » You may have heard that Medicaid is a payer of last resort, a requirement that Medicaid providers bill other payers first when Medicaid enrollees have other forms of insurance, such as Medicare. But providers should note that Medicare is not always the payer of first resort.
Continue reading » Providers may have heard that they are required to provide in certain instances Medicare beneficiaries with an Advanced Beneficiary Notice of NonCoverage (ABN) but the specifics of the requirements may not be known to everyone.
Continue reading » Nowadays State and Federal governments are focused on making healthcare fraud, waste and abuse their top priorities. In furtherance of this goal, the Centers for Medicare & Medicaid Services (“CMS”) announced recently that starting July 1, it will begin using innovative predictive modeling technology to fight Medicare fraud.
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