DME Company Operators Convicted of Health Care Fraud

Two workers from a durable medical equipment company (DME) in Louisiana were convicted of healthcare fraud and kickbacks on July 29 for their parts in submitting false reimbursement claims to Medicare for enteral nutrition that the company purportedly provided to Medicare beneficiaries. Imeh Ebere pled guilty to submitting numerous fraudulent claims to Medicare through her company for enteral nutrition related products that she had purportedly provided to Medicare beneficiaries, even though the beneficiaries did not have feeding tubes, which is how enteral… Read More >

CMS Proposes Welcomed Changes to the Medicare Home Health Face-to-Face Requirement

On July 1, 2014, CMS published the 2015 Home Health Prospective Payment System Rate Update proposed rule, which included proposed changes to the home health face-to-face encounter requirement. The face-to-face encounter, a requirement added by the Affordable Care Act, requires that prior to certifying a patient’s eligibility for Medicare’s home health benefit, the physician must document that the physician himself or an allowed non-physician practitioner (NPP) had a face-to-face encounter with the patient. The current face-to-face encounter requirements call for… Read More >

Anti-Kickback and Stark Law Whistleblower Suit Results in $24.5 Million Settlement

The Department of Justice released a statement on Monday July 21, 2014 discussing a recent $24.5 million settlement with Alabama-based Infirmary Health System Inc. (IHS), two IHS-affiliated clinics and Diagnostic Physicians Group, P.C. (DPG).  The settlement resolved a lawsuit alleging violations of the False Claims Act as a result of claims submitted in violation of the Anti-Kickback Statute and the Stark Law. The government’s lawsuit, which was initiated by a whistleblower, alleged that the hospital affiliated clinics entered into an… Read More >

Senate Report Finds Medicare Audit Programs Have Failed to Reduce Improper Payment Rate

The Senate Special Committee on Aging recently issued a report addressing the current Medicare audit programs, the impact of these programs on reducing improper payment rates and the burden providers face when undergoing a Medicare audit. The report outlines inefficiencies related to the lack of coordination among the audit contractors and the failure to effectively target problem providers or problem areas. The report notes that in fiscal year (FY) 2013, CMS reported an estimated $50 billion in Medicare fee-for-service improper… Read More >