Includes 29 MS-DRGs for Medical Necessity Review Connolly Healthcare posted a new approved issue calling for DRG Validation review of 309 MS-DRGs and/or 141 ICD-9 diagnosis codes, on Thursday evening, March 17, 2011. Connolly is the CMS Recovery Audit Contractor for Region C, responsible for audits of healthcare providers who bill Medicare in 17 states […]
From the Report Introduction: The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105–33) to advise the U.S. Congress on issues affecting the Medicare program. Two reports—issued in March and June each year—are the primary outlets for Commission recommendations. This report contains 13 chapters: […]
Testimony of Daniel R. Levinson, Inspector General on March 9, 2011 before the United States Senate Committee on Homeland Security & Governmental Affairs, Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security on New Tools for Curbing Waste and Fraud in Medicare and Medicaid. Excerpt from the testimony: OIG Work Highlighting the […]
Double-billing Alleged Jersey City, N.J., physiatrist Monica Mehta, M.D., paid $2.25 million in a civil settlement agreement with the New Jersey U.S. Attorney’s Office to resolve allegations that she double-billed federal health care programs, U.S. Attorney Paul J. Fishman announced. The government is represented by Assistant U.S. Attorney Alex Kriegsman of the U.S. Attorney’s Office […]
Thomaston Pediatrician Pleads Guilty to Medicaid Fraud Kathy Mansfield, a Thomaston pediatrician and owner of Pediatric Associates of Thomaston, Inc., pled guilty yesterday to one count of Medicaid Fraud for intentionally overbilling the Medicaid Program in the amount of approximately $537,428. From 2003 to 2007, Mansfield billed Medicaid for the Synagis, a drug used to prevent […]
Proposed notices detail information insurance plans would have to give to consumers to justify rate increases over 10 percent Monday, the Centers for Medicare & Medicaid Services (CMS) published proposed consumer disclosure notices, required by the Affordable Care Act, that insurers would be required to complete and report electronically when they propose rate increases over […]
Action marks first civil money penalty issued by HHS for HIPAA Privacy Rule violations The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, Md., (Cignet) violated the Privacy Rule of the Health Insurance Portability and […]
Region C List Riddled with Errors Two of the CMS Recovery Audit Contractors (RAC) posted newly approved issues last week to their public websites, as required by CMS before widespread review of those issues can begin. Connolly Healthcare, the RAC for CMS Region C posted 36 new issues on their Approved Issues webpage, on Wednesday, […]
23 New Issues Approve Medical Necessity Review for 70 DRGs Connolly Healthcare, the Recovery Audit Contractor (RAC) for 17 states posted 77 new issues on their Approved Issues webpage, late in the day on Friday, January 14, 2011. Once again, continuing the pattern that healthcare providers have come to expect from the 4 RACs and […]