Compliance News Roundup: Inpatient Rehabilitation Facilities

1. Medicare Advantage Provider to Pay $270 Million to Settle False Claims Act Liabilities – ‘“Federal healthcare programs rely on the accuracy of information submitted by healthcare providers to ensure that managed care plans receive the appropriate compensation,” said Assistant Attorney General Joseph H. Hunt of the Department of Justice’s Civil Division. “We will pursue those who undermine the integrity of the Medicare program and the data it relies upon. This also illustrates that the Department encourages and incentivizes healthcare organizations to make voluntary disclosures to the government when they identify false claims.”’ Get the full scoop >>

2. Kalispell Regional Healthcare System to Pay $24 Million to Settle False Claims Act Allegations – ‘“Financial arrangements that improperly compensate physicians who make referrals to a hospital drive up the cost of health care services for everyone,” said Assistant Attorney General Joseph H. Hunt for the Department of Justice’s Civil Division.  “This settlement demonstrates the Department’s determination to enforce federal laws aimed at preventing conflicts of interest between the financial interests of hospitals and physicians and the best interests of the patients they serve.”’ Get the full scoop >>

3. Deeper Than the Headlines: Inpatient Rehabilitation Facilities – “According to the OIG’s most recent, published report, many inpatient rehabilitation facility (IRF) stays did not meet Medicare coverage and documentation requirements.  According to their review, IRFs complied with all Medicare coverage and documentation requirements specified for reasonable and necessary care for 45 of the 220 sampled stays. However, for 175 of the sampled stays, corresponding to 135 IRFs, medical record documentation did not support that IRF care was reasonable and necessary in accordance with Medicare’s requirements. These errors occurred because many IRFs did not have adequate internal controls to prevent inappropriate admissions. Based on their sample results, OIG estimated that Medicare paid IRFs nation-wide $5.7 billion for care to beneficiaries that were not reasonable and necessary.”  Get the full scoop >>

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