When is an Overpayment Identified?

The Affordable Care Act (“ACA”) amended the False Claims Act (FCA) “reverse false claims” provision to include an obligation that providers report and return any overpayment within 60 days of identification.  However, the ACA did not define identification which has caused considerable confusion among health care providers. In the recent whistleblower/false claims case of Kane v. Healthfirst, Inc., a federal district court judge has defined the term very narrowly, to mean that the overpayment is identified when the provider is… Read More >

OIG Report Calls for Greater Oversight of Home Health Face-to-Face Requirement

A recent report from the Office of Inspector General (OIG) for Health and Human Services (HHS), is calling upon CMS to increase scrutiny of home health claims – specifically the required face-to-face documentation.  According to a report released April 9, 2014 on the OIG’s website, 32 percent of 644 randomly selected home health claims reviewed did not have documentation meeting the Medicare requirements for a face-to-face visit.  The OIG alleged that the insufficient documentation amounted to 2 billion dollars worth… Read More >