Healthicity Blog

For many years now the OIG has been performing Medicare Compliance reviews of hospitals.

For those of you unfamiliar with coding and billing, modifier -59 is a two-digit numeric code modifier that can be appended to a CPT or HCPCS procedure code, for example, and will frequently bypass many payor edits.

When a lot of healthcare organizations consider their risk under the False Claims Act, they often think of coding and billing errors submitted on 1500s or UBs. It’s probably the first place I’d consider looking as well for the greatest risk to a Medicare or Medicaid healthcare provider.

1. Surgery center says 34,000 patient records potentially breached - “St. Mark’s Surgery Center was hit by a ransomware attack that may have impacted the personal health information of 33,877 patients.

Many compliance programs rely on the OIG Work Plan when planning their own internal audit or compliance activities. Historically, the OIG Work Plan was updated annually. However, recently the OIG has been publishing periodic updates and additions more often.

The OIG has frequently reviewed chiropractic services over the last several years. Their most recent report was posted on their website on Aug. 18, 2017 and concluded that a Brooklyn chiropractor had a 100% error rate for claims over a two-year period worth about $672,000.

340B Drug Pricing Program

The 340B drug pricing program was authorized by Congress in 1992 to generate savings for certain safety-net healthcare providers by allowing them to purchase outpatient drugs at discounted prices. It is estimated that the savings to 340B providers attributable to the...

1. Three Companies and Their Executives Pay $19.5 Million to Resolve False Claims Act Allegations Pertaining to Rehabilitation Therapy and Hospice Services