By Deniza Gertsberg, Esq., on July 27th, 2011 The Centers for Medicare & Medicaid Services (CMS) and the New York State Office of the Mediciad Inspector General (OMIG) have teamed up to analyze and measure whether improper payments in the Medicaid and State Child Health Insurance programs have been made to healthcare providers. Under the Payment Error Rate Measurement (PERM) program, which was developed to comply with the Improper Payments Information Act (IPIA; Public Law 107-300) of 2002, each federal agency is required to annually identify programs that may be susceptible to significant and improper payments, estimate the amount of improper payments, submit the estimated amounts to Congress and also submit a report on actions the agency is taking to reduce the improper payments.
Continue reading »
By Deniza Gertsberg, Esq., on July 12th, 2011 Many New York State healthcare providers have recently felt the heavy hand of the state enforcement agency as the Office of Medicaid Inspector General (OMIG) seeks to recoup payments paid out to providers in an effort to eliminate fraud, waste and abuse in the healthcare industry. At a recent presentation given by OMIG, the agency identified the following core requirements for all healthcare providers that participate in the Medicaid program:
Continue reading »
By Deniza Gertsberg, Esq., on July 12th, 2011 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.
Continue reading »
By Deniza Gertsberg, Esq., on July 6th, 2011 There is an increased focus on the dental community from the New York State Office of Medicaid Inspector General (OMIG). At an increasing rate, OMIG is conducting audits of dentists and dental specialists, putting additional burden on providers already taxed with other statutory, regulatory and malpractice concerns.
Continue reading »
By Deniza Gertsberg, Esq., on June 22nd, 2011 At a recent Health Care Fraud Prevention and Enforcement Action Team presentation given by the Office of Inspector General (OIG), the agency stressed the importance of documentation and identified the following seven common billing abuses performed by providers.
Continue reading »
By Deniza Gertsberg, Esq., on June 22nd, 2011 In addition to any state laws that may impact a doctor’s practice, the main civil Federal laws and their implementing regulations that concern physicians are the False Claims Act, the Anti-Kickback Statute, the Physician Self Referral Act (often called the Stark Law), the Exclusion Statute, and the Civil Monetary Penalties Law. An additional law that impacts the practice of medicine is the Health Insurance Portability and Accountability Act (HIPAA).
There are also criminal statutes related to fraud and abuse in the context of health care. The most frequently cited Federal statutes include Health Care Fraud, Theft or Embezzlement in Connection With Healthcare, False Statement Relating to Health Care Matters, Obstruction of Criminal Investigations of Health Care Offense, Mail and Wire Fraud, and Criminal Penalties For Acts Involving Federal Health Care Programs.
Continue reading »
By Deniza Gertsberg, Esq., on June 22nd, 2011 In order to meet the enhanced program integrity provision of the Affordable Care Act, signed by President Barack Obama in March 2010, as well as the New York False Claims Act signed by Governor David Paterson in August 2010, the Office of The Medicaid Inspector General (OMIG) is ramping up the number of investigations and audits of the State’s healthcare providers. Even before these laws were implemented, OMIG was under pressure to produce results.
Continue reading »
|
|
