Compliance News Roundup: OIG Work Plan Items for Jan 2018, Explained

1. Scripps Health to Pay $1.5 Million to Settle Claims for Services Rendered by Unauthorized Physical Therapists – “Scripps Health (Scripps), a health care system based in San Diego, California, has agreed to pay $1.5 million to resolve allegations that it violated the False Claims Act by charging federal health care programs for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider, the Justice Department announced today.” Get the full scoop >>

2. Attorney General Josh Stein Announces Settlement With Raleigh Dentist Over Medicaid Claims – “Attorney General Josh Stein today announced a settlement with Javeria Nasir, a dentist in Raleigh. Dr. Nasir allegedly submitted fraudulent claims to the North Carolina Medicaid program. Allegedly, Dr. Nasir submitted claims between Jan. 1, 2015 and July 31, 2017, for “extended care facility calls” and “full mouth debridements” that were not medically necessary, had no supporting clinical documentation, and were performed in violation of Medicaid policy.” Get the full scoop >>

3. Deeper Than the Headlines: OIG Work Plan Items for Jan 2018 Explained – The OIG has updated their work plan with its January 2018 additions, like the questionable billing for off-the-shelf orthotic devices. This particular item seems to have been added as a result of a MAC (Medicare Administrative Contractor) who identified high improper payment rates in their jurisdiction for three specific off-the-shelf orthotic devices. Let’s take a deep dive into the devices, their corresponding HCPCS code, and what it means for you as a compliance professional. Get the full scoop >>