Combating Healthcare Fraud?

By http://www.MCOL.com

In Healthcare Plans and Accounts

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2 Responses

  1. HC Finance: 8 Healthcare Frauds & Settlements in 2017

    1. Provider hit with $31,000 HIPAA settlement over business associate’s agreement
    2. Theranos reaches $4.65 million settlement with Arizona Attorney General office
    3. HHS settles with Denver provider for $400,000 for 2011 breach
    4. Oklahoma’s Norman Regional Health System pays $1.6 M to settle MC allegations
    5. Nursing home operator pays $1 million over alleged false genetic testing claims
    6. Sanofi-Pasteur to pay $20 million penalty for overcharging Veterans Affairs
    7. Texas MD convicted in $40-M MC home health fraud faces decades in prison
    8. Eight Texans indicted in $158 million healthcare fraud scheme involving pricey compound pain medications

    Source: HC Finance

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  2. CMS Overhauling Medicare Fraud Audit Process

    The CMS has unveiled a major overhaul of how it pursues Medicare fraud and improper payment cases. The agency plans to implement a new audit strategy in which Medicare administrative contractors, or MACs, will scan claims and only target providers and suppliers with the highest error rates or billing practices that vary significantly from their peers.

    Currently, MACs largely flag and challenge claims at random, a process that has led to a high backlog in appeals that the agency is struggling to work its way through. The new audit process builds off an effort that started in 2014 for select claims called probe-and-educate reviews. Under this effort, the CMS combined a review of a sample of claims with education to help reduce errors in the billing submission process.

    Source: Virgil Dickson, Modern Healthcare [8/15/17]

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