The bill known as the “21st Century Cures,” H.R.6, would extend Civil Monetary Penalties (CMPs) to cover false claims and false statements relating to grants, contracts, and other agreements funded by the Department of Health & Human Services (HHS). Falsehoods relating to clinical trials appear to be a …
Out of the Mouths of Babes: Millions of Medicaid Dollars
May 19, 2015 Leave a Comment
Last Monday the Office of Inspector General of Health & Human Services posted a hair-raising report. “Questionable Billing for Medicaid Pediatric Services in California” raises alarming questions about the billing practices and service quality of some of that state’s dentists—especially those working …
House Bill Says 23 Years Isn’t Long Enough for Transition to ICD-10
May 13, 2015 Leave a Comment
All across the country hospitals have been bracing for the scheduled Oct. 1, 2015, transition from ICD-9 coding to ICD-10. It had been scheduled for Oct. 1, 2014, but the Protecting Access to Medicare Act of 2014 delayed it until Oct. 1, 2015. Before that it was scheduled for Oct. 1, 2013, but in 2012 the …
New CMS Ruling on DSH Appeals for FY 2004 and Earlier
April 29, 2015 Leave a Comment
It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued Ruling No. CMS-1498-R2, addressing the nettlesome issue of how to treat certain …
This Just in: OIG Rules Free Diapers Are Not an Illegal Kickback
February 11, 2015 Leave a Comment
The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services. In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider may give free diapers to Medicaid mothers without fear of federal …
Annual Penny-Wise, Pound-Foolish Award Winner Announced
December 23, 2014 Leave a Comment
When it comes to the annual Penny-Wise, Pound-Foolish Award, don’t ever bet against the United States Congress. This year, Congress lay back in the weeds until the year was almost over before making its move for the trophy. But when it finally came, what a move it was! Under the Congressional spending …