Compliance News Roundup: OIG Medicare Compliance Reviews

1. Meadows Regional Medical Center, Inc. and Affiliates To Pay Up To $12.875 Million To Resolve Alleged False Claims Act Violations - “Meadows Regional Medical Center, Inc. (“Meadows”) and others have agreed to pay the United States and Georgia a total of up to $12,875,000 to resolve allegations that they violated the False Claims Act. The United States and State of Georgia contended that Meadows and others violated and conspired to violate the False Claims Act by submitting claims referred by physicians with whom Meadows had improper compensation arrangements, in violation of the Stark Law and the Anti-Kickback Statute. As part of the settlement, Meadows has also entered into a corporate integrity agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG).” Get the full scoop >>

2. Doctor And Wife From Wayne, New Jersey, Plead Guilty In Test-Referral Bribe Scheme With New Jersey Clinical Lab - “A cardiologist with a practice in Paterson, New Jersey, and his wife pleaded guilty today to their involvement in a test-referral bribe scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates, Acting U.S. Attorney William E. Fitzpatrick announced.

Aiman Hamdan, 50, pleaded guilty before U.S. District Judge Stanley R. Chesler to a superseding information charging him with accepting bribes in violation of the Federal Travel Act. His wife, Kristina Hamdan, 39, pleaded guilty before Judge Chesler to Counts One and Thirteen of an indictment charging her with conspiracy to violate the Anti-Kickback Statute, the Federal Travel Act and the honest services wire fraud statute, and conspiracy to commit money laundering.” Get the full scoop >>

3. Deeper Than the Headlines: OIG Medicare Compliance Reviews - “In this week’s Deeper Than the Headlines, I’ll dive into Medicare and noncompliance with billing requirements. Medicare payments to hospitals is big business. In 2015, for example, Medicare paid hospitals $163 Billion which represents 46% of all fee-for-service payments for the year. In performing these compliance reviews, the OIG uses computer matching, data mining, and data analysis techniques to identify hospital claims that are at risk for noncompliance with Medicare billing requirements.

In the Rush compliance review, they reviewed a stratified random sample of 120 inpatient and outpatient claims with payments totaling $1.7 million for the chosen audit period. They concluded the hospital complied with Medicare billing requirements for 63 of the 120 inpatient and outpatient claims reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 57 claims, resulting in overpayments of $814,150 for calendar years 2014 and 2015. Specifically, 51 inpatient claims had billing errors, resulting in overpayments of $812,744, and 6 outpatient claims had billing errors, resulting in overpayments of $1,406. According to the OIG, 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 >>

Questions or Comments?