Compliance Program – What are the Requirements to Implement an Effective Program

All sponsors are required to adopt and implement an effective compliance program,which must include measures to prevent, detect and correct Part C or D program noncompliance as well as FWA.
 The compliance program must, at a minimum, include the following core requirements:
 1. Written Policies, Procedures and Standards of Conduct;
 2. Compliance …

Understanding RAC

Recovery Audit Contractors, also known as RAC, is a program that seeks to identify and correct improper payments for services provided to Medicare Parts A & B beneficiaries.  This includes both recoupment of overpayments and corrected distribution of underpayments made by CMS.   RAC began in 2005 as a three-year demonstration project consisting …

Patient Electronic Access Tipsheet – Measure Compliance

MEASURE COMPLIANCE – Meeting the Patient Electronic Access Objective
Starting in 2014, CMS requires that providers participating in both Stage 1 and Stage 2 of the EHR Incentive Programs must meet the Patient Electronic Access objective, which gives patients access to their health information in a timely manner. Providers participating in …

Healthcare Fraud Investigations in FY 2013

Enforcement Actions in FY 2013: the Department of Justice (DOJ) opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants. Federal prosecutors had 2,041 health care fraud criminal investigations pending, involving 3,535 potential defendants, and filed criminal charges in 480 cases involving 843 defendants. A total of 718 …

How can I make sure new hires have not been in trouble with Medicare?

To avoid liability, it is recommended to routinely check (every 3 months) the LEIE to ensure that new hires and current employees are not on the excluded list.

One of the many parts of the compliance program is to see if your current staff (including yourself, regular staff and associate doctors) have been placed on the OIG (Office of the Inspector General) List of Excluded Individuals and Entities (LEIE).
OIG has the authority to exclude individuals and entities from Federally funded health care programs and maintains a list (List of Excluded Individuals and Entities or LEIE)of all currently excluded individuals and entities. Anyone who hires an individual or entity on the LEIE may be subject to monetary penalties.
It’s as simple as 1…2…3..
Read More