Compliance News Roundup: Nurse Arrest Prompts Policy Change

1. Medicare Compliance Review of Parkridge Medical Center, Inc., for 2014 and 2015 - “Medicare Compliance Review of Parkridge Medical Center, Inc., for 2014 and 2015 Parkridge Medical Center, Inc. (the Hospital), located in Chattanooga, Tennessee, complied with Medicare billing requirements for 88 of 100 inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 12 claims for the audit period (calendar years 2014 and 2015). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $201,808 for the audit period. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.” Get the Full Scoop >>

2. Vulnerabilities Remain in Medicare Hospital Outlier Payments - “The summarized results of our individual Medicare contractor reviews (issued between June 2014 and September 2015) revealed that for the period October 2003 through March 2011, Medicare contractors did not always refer Medicare cost reports that qualified for reconciliation, and the Centers for Medicare & Medicaid Services (CMS) did not always ensure that Medicare contractors reconciled the outlier payments associated with cost reports that had been referred. CMS relies on Medicare contractors to reconcile outlier payments, which compensate hospitals for high-cost cases. These reconciliations ensure that outlier payments reflect hospitals' actual costs.” Get the Full Scoop >>

3. Deeper Than The Headlines: Nurse Arrest Prompts Policy Change - Most of us have seen the emotionally charged video of University of Utah nurse, Alex Wubbels, being arrested by Salt Lake City Police after refusing to allow the police to draw blood from an unconscious patient. Since the July 26th event, both the mayor and chief of police have apologized and the police officer’s lawyer has recently said his client would like an opportunity to apologize, too. The FBI was asked to investigate and it is unknown if the nurse will eventually file suit against the city. Those of us in health care, and in the compliance field in particular, have probably asked ourselves, how did this happen (and how could it have been prevented)? Get the Full Scoop >>