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.
July-August 2009 - Table of Contents
Laboratory outreach programs face some special billing challenges since the patients they are serving are registered neither as inpatients nor outpatients in the hospital. As such, outreach programs must be especially careful in how they bill for their services, notes Peter Kazon, an attorney with Alston & Bird (Washington, D.C.).
A federal appeals court June 2 denied a laboratory’s petition for review regarding the one-year revocation of its Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate because it checked its answers with those of another lab before submitting its test results to the government (Wade Pediatrics v. HHS).
A nonprofit charitable group can help financially needy Medicare and Medicaid patients pay their cost-sharing amounts for advanced diagnostic testing used in treating HIV and colon cancer without risking federal civil penalties, the Department of Health and Human Services Office of Inspector General (OIG) said in a May 18 advisory opinion (No. 09-04).
On May 20, 2009, President Obama signed into law the Fraud Enforcement and Recovery Act of 2009 (FERA), which significantly amends the federal False Claims Act (FCA) and expands the potential liability for all companies doing business with the government.1 On the same day, Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius announced a new Health Care Fraud Prevention and Enforcement Action Team (HEAT), which increases the resources available to investigate and prosecute allegations of health care fraud.
Quest Diagnostics (Teterboro, N.J.) has issued a clarification concerning its recent settlement with the federal government over charges that a former subsidiary sold misbranded test kits.
A federal district court in Hawaii May 29 sentenced a former compliance officer to 40 months in prison and ordered her to pay $639,430 in restitution after she pleaded guilty to fraud by entering into contracts with a hospital for consulting services she actually performed as an employee (United States v. Syling).
The Centers for Medicare & Medicaid Services (CMS) has ruled that global billing is “not appropriate” for the professional component (PC) and the technical component (TC) of pathology services performed by the same independent laboratory but on different dates of service. In this case, the TC and the PC are to be billed as separate line items.
RAC Requests: Medicare providers in some parts of the country will begin receiving records requests from recovery audit contractors by July as the full post-payment review program begins rolling out nationwide, according to a spokesman for the Centers for Medicare & Medicaid Services (CMS). CMS does not expect RACs to begin conducting complex reviews that would include medical necessity reviews until 2010, after the contractors have established themselves in their respective regions, the spokesman said. …
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