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McBrayer Blogs
Showing 55 posts in Medicaid.
Federal Government Fight Against Health Care Fraud
FIFTEEN YEARS - $20.6 BILLION – NOT BAD!! More >
CMS Has Issued Proposed Rule Which Would Force Providers to Report Overpayments in 60 Days
The Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations on Tuesday, February 14, 2012 proposing that providers and suppliers must report any self-identified overpayments within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is the latter. More >
ON THE ENFORCEMENT RADAR: MEDICAID AUDITS AND THE 2012 OIG WORK PLAN
Unlike the Department of Health and Human Services Office of Inspector General (“OIG”) which publishes a Work Plan each year, the Department of Medicaid Services (“Medicaid”) generally does not publish guidance on the areas which it plans to investigate and/or audit. In fact, Medicaid’s website states … “Medicaid does not provide guidance on how companies should bill for services, but will direct you to applicable regulations. If you receive direction from staff about how to bill, the Department will not be bound by such instruction, unless it was given by a Director or Commissioner.” Because the federal integrity programs are now moving through the process, Kentucky Medicaid providers are starting to see lots of audit activities. Unlike the OIG audits, we don’t know the precise subject matter of the Medicaid audits, but the process for appeal is outlined below in addition to the areas announced for review by the OIG. More >
ON THE ENFORCEMENT RADAR: THE 2012 OIG WORK PLAN
The Office of Inspector General of the United States Department of Health and Human Services (OIG) released its Work Plan for fiscal year 2012. At the beginning of each fiscal year, the OIG issues its annual Work Plan, which describes current audit, enforcement and evaluation activities and those the agency plans to initiate in the upcoming year. The Work Plan also provides a general view of the OIG’s investigative, enforcement and compliance activities. Basically, the Work Plan informs health care providers what is on the OIG’s enforcement radar in the coming year. Physicians should know what areas that the OIG is concerned about and review their own practices to ensure compliance with regulatory requirements. The following are some of the highlights from the FY 2012 Work Plan. More >
Courier Journal publishes online prescription database
The Courier Journal recently published an online database allowing the public to search, by prescriber last name or zip code, the number of prescriptions Kentucky doctors and other prescribers wrote between 2001 and 2011 for seven commonly-abused drugs: alprazolam, diazepam, morphine, methadone, fentanyl, oxycodone and hydrocodone. The newspaper accessed information from Kentucky’s Department for Medicaid Services via the Open Records Law, so the database is limited to Medicaid claims data. As Senator Grassley (R-IA) and other senators raise concerns that over-prescribing may constitute fraud and abuse, it is important for Kentucky physicians and prescribers to comply with compliance plans, state and federal laws, as well as Kentucky Board of Medical Licensure guidelines. More >
