Compliance News Roundup: Hospital Compliance Review

1. Physician Sentenced to Prison for False Billing Scheme – “A physician at the now-defunct New England Pain Management Associates Inc. was sentenced today in federal court in Boston for conspiring to falsify patient medical records in order to obtain payments from Medicare and commercial insurers for medical services that were not performed.” Get the full scoop >>

2. Dunedin Psychologist Pleads Guilty To Obstruction Of A Medicare Audit – “Dr. Charles Gerardi (76, Dunedin) has pleaded guilty to obstructing a Medicare audit. He faces a maximum penalty of 5 years in federal prison. A sentencing date has not yet been set.” Get the full scoop >>

3. Deeper Than the Headlines: Hospital Compliance Review – If you’re a compliance professional at a hospital you are probably aware of the series of compliance reviews that the OIG has been performing for many years. If you’re not aware you should be. Essentially, the OIG uses data mining and analytic techniques to identify hospitals that might have high error rates when it comes to hospital billing and reimbursement for Medicare patients. Once they identify outliers they perform focused reviews and typically find high error rates. Well, Community Hospital in Munster, Indiana is the latest hospital to have such a review and the OIG published their report in February 2019. For the calendar year 2017, Medicare paid hospitals $206 billion, which represents 55% of all fee-for-service payments for the year. That is some real money. It’s no wonder the OIG has been focusing on hospital compliance reviews. Get the full scoop >>