Healthicity Blog

Many Tribal programs receive funds from the Department of Health and Human Services (HHS). Have you ever wondered if you’re meeting all the requirements to protect that revenue stream and the beneficiaries it’s intended to serve?

EXAMPLES OF MODIFIER 59 ERRORS

Your organization is losing money. The OIG HHS reported that nearly 42% of Medicare claims for E/M services are incorrectly coded resulting in $6.7 billion in overpayments.

According to a recent post on Justice.gov, “A Detroit, Michigan-area doctor was sentenced to 72 months in prison today for his role in a $10.4 million conspiracy to defraud the Medicare program.”

When most of us hear about OCR enforcement we immediately think about HIPAA, and rightfully so. There’s no doubt that HIPAA has definitely been a big enforcement area for OCR, but remember that OCR stands for the “Office for Civil Rights” and they oversee other areas of enforcement as well.

1. Kmart Corporation to Pay U.S. $32.3 Million to Resolve False Claims Act Allegations for Overbilling Federal Health Programs for Generic Prescription Drug -

Which entity is the largest grant-making organization in the federal government? If you guessed HHS, then you are right. HHS provides more grants than any other group in the federal government. And as most compliance officers know, risk and enforcement tends to follow the money.

1. Dallas-Based Physician - Owned Hospital to Pay $7.5 Million to Settle Allegations of Paying Kickbacks to Physicians in Exchange for Surgical Referrals -

On November 30th, the OIG posted its Semiannual Report to Congress. The report is a summary of the OIG’s activities from April 1, 2017 to September 30, 2017.