Last week, the Department of Justice (DOJ) announced a $516,718 false claims settlement related to improper billing of mid-level practitioner services...
New Modifier Requirements for Reporting Drugs and Drug Waste
CMS has issued updated guidance regarding the appropriate billing of drugs/biologicals. The new guidelines apply to all providers and are effective ...
OIG Plans New Compliance Guidance and Issues a New Toolkit
On Tuesday, Inspector General Grimm made several important announcements during her presentation at the Healthcare Compliance Association’s Complian...
DOJ Guidance on Evaluating Compliance Effectiveness
The Department of Justice (DOJ) has issued an update to their Evaluation of Corporate Compliance Programs (ECCP) guidance document. They have also a...
CMS is Ending Certain PHE Waivers
Last week, CMS issued guidance for providers pursuant to the announcement on February 9th that the Public Health Emergency (PHE) for COVID-19 will end...
Time-Based Services Under Scrutiny
Last week CMS issued Transmittal 11842. The Transmittal outlines changes to the instructions for Evaluation and Management (E/M) services within...
CMS Medicare Advantage Final Rule Takes Aim at Risk Adjustment Coding
Yesterday, CMS released the Medicare Advantage (MA) Risk Adjustment Data Validation Final Rule. The Final Rule is intended to strengthen the acc...
2022 Medicare Improper Payments Data
2022 Medicare Fee-For-Service Improper Payments Report was just released. The report identified an estimated $31.46 billion in improper payments...
OIG Fall 2022 Semiannual Report
The OIG has issued their Semiannual Report to Congress for the period April 1, 2022 through September 30, 2022. The report highlights over $4 billi...
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