YouCompli
FEBRUARY 22, 2023
Allegedly, the facility also failed to fully reimburse the government for its receipt of these outlier payments after it became aware of the issue. The government alleged these increased charges resulted in the greater number of outlier payments. Return illegitimate reimbursement and overpayments quickly.
Healthcare IT News - Telehealth
JUNE 8, 2022
State government executive orders. Additionally, any reimbursement resulting from these claims could be considered an overpayment. Once a provider has credible evidence of an overpayment, it must be reported and returned to avoid triggering FCA liability. Legislation or temporary regulatory flexibilities tied to the PHE.
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Med-Net Compliance
OCTOBER 21, 2022
The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. Excluded individuals and entities are listed in the OIG’s exclusions database.
C&M Health Law
DECEMBER 18, 2023
OIG specifically references the United States Sentencing Commission’s Guidelines that require that an entity’s “governing authority shall be knowledgeable about the content and operation of the compliance and ethics effectiveness of the compliance and ethics program.”
Healthcare Law Blog
FEBRUARY 9, 2024
Sherman himself had submitted disclosure logs to the OIG), Sherman alleges that it failed to adequately report the arrangements it had with Neonatology Associates or any other private physician groups, or return any alleged overpayments.
Healthcare IT Today
MAY 5, 2023
The surge in genetic testing claims comes with a rise in fraud, waste and abuse across government and commercial payers. When requests for genetic testing from a specific lab or provider—in total or by type of test—rise substantially, this presents an opportunity for health plans to uncover the “why.”
AIHC
APRIL 5, 2022
Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.
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