G-2 Compliance Report
G-2 Compliance Report is designed to guide hospital, lab, and pathology professionals in developing, implementing and revising compliance programs to meet federal standards. In every issue, you’ll get practical advice and information you need to: Stay on top of fast-changing federal mandates Structure business arrangements to prevent fines Reduce exposure to whistleblower lawsuits Maintain public trust and thwart negative publicity And more With the continued emphasis on healthcare fraud by the Justice Department and HHS Office of Inspector General —and record-setting fines and settlements—don’t take the risk of being caught unprepared for an investigation and audit.
March 2010 - Table of Contents
Federal health care anti-fraud efforts at the Department of Health and Human Services (HHS) would receive a boost of $250 million in funding over last year’s budget request, and the Medicare Fraud Strike Force program would be expanded, under the proposed fiscal year 2011 budget, released Feb. 1.
The U.S. Supreme Court has dismissed a challenge to its ruling last year that lab analysts and other forensic specialists must be available to testify in person at trials. The court ordered the case, Briscoe v. Virginia, back to state court for further consideration.
Eight national laboratory and pathology professional and scientific groups have urged congressional leaders to act quickly to restore the pathology "grandfather" protection that expired Dec. 31, 2009, saying it is needed to maintain quality testing and access to testing by Medicare beneficiaries, especially in rural areas.
The American Clinical Laboratory Association (ACLA) is recommending several changes to the Clinical Laboratory Improvement Amendments (CLIA) and its interpretive guidelines that it believes will help facilitate the exchange of electronic laboratory data.
The first two months of 2010 have seen the political stars align for the passage of stand-alone health care fraud legislation. First came the election of Sen. Scott Brown (R-Mass.) on Jan. 19, 2010, which delivered a serious blow to passage of the Senate’s comprehensive health care reform bill and therewith the sweeping health care fraud initiatives contained within that bill.
The former owner and manager of a Detroit-area clinic was sentenced Feb. 4 to 63 months in prison for her role in a $2.3 million Medicare fraud conspiracy, the Department of Justice said (United States v. Briceno, S.D. Fla., No. 09-20748).
A federal district court in California sustained a final decision by the health and human services secretary that an independent diagnostic testing facility (IDTF) was not entitled to Medicare reimbursement because it failed to include required documentation of medical necessity in its claims (KGV Easy Leasing Corp. v. Sebelius, C.D. Cal., No. 2:08-cv-06281-DSF-RZ, 1/29/10).
NEW ANTI-FRAUD BILL INTRODUCED: An anti-fraud bill introduced Jan. 28 by Sen. Chuck Grassley (R-Iowa) incorporates numerous provisions from the Senate’s health care reform bill (H.R. 3590), including enhanced screening for providers who want to participate in federal health care programs, as well as improved coordination among the various federal agencies given the task of fighting health care fraud.
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