CMS reported that it plans to begin audits that would include chart reviews for validity of diagnoses in 2020 after a recent study by the Office of Inspector General (OIG). The study found potential issues with the extent to which chart reviews are leveraged by Medicare Advantage Organizations...Read More »
Carolinas Hospital in Florence, South Carolina, received $431,757 in Medicare overpayments for incorrectly billed inpatient and outpatient services based on a sample of claims, according to an Office of Inspector General (OIG) audit report released November 26. The OIG estimates that, based on...Read More »
Oceanside Medical Group, a clinic providing mental health services in Santa Monica, California, is disputing an Office of Inspector General (OIG) report that estimated the group received $2.6 million in overpayments for...Read More »
The 2019 ACDIS Symposium: Outpatient CDI, which takes place November 14-15 at the Hyatt Regency in Austin, Texas, is shaping up to be a wonderful event. With two consecutive educational tracks and more than 20 speakers,...Read More »
This morning, two OIG representatives, Truman Mayfield, CPA, CPE, and Scott Perry, CPA, took the stage to discuss the OIG’s Work Plan, audit activities, and offer some words of wisdom (and perhaps consolation) to those under OIG scrutiny. To kick off the session, Mayfield discussed the ins and...Read More »
Essence Healthcare Inc., a health maintenance organization (HMO) with a Medicare contract based in Missouri and Southern Illinois, submitted incorrect claims for acute stroke and major depressive disorder that did not comply with federal requirements, resulting in $158,000 in overpayments to...Read More »
Community Hospital in Munster, Indiana, disputes an OIG report that found DRG assignment errors and incorrect IRF claims, resulting in an projected $22,051,602 in overpayments.Read More »
Federal fraud watchdog agencies may be taking a closer look at Medicare Advantage in 2019, according to a recent report released by Bass, Barry & Sims, a Washington, D.C.-based law firm.Read More »
