OIG RAT-STATS: Response Strategies to Government Audits
The Centers for Medicare and Medicaid (CMS) are now combating provider fraud, waste, and abuse through nationally coordinated strategies and…
Advance Beneficiary Notice Form: CMS Announces New ABN Modifiers
In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented the use of the revised Advance Beneficiary Notice Form…
Meet Richard Kusserow, Former HHS Inspector General, CEO of Strategic Management
Richard Kusserow is the former Inspector General for the Department of Health and Human Services (HHS) and is CEO of…
GAO Yellow Book Standards and Independent Review Organizations
The heightened focus on health care fraud, waste, and abuse at both the Federal and State levels in recent years…
An Update on the RACs Activities DRG Validation
This article highlights vulnerable areas that hospitals should take into consideration, along with specific tips for identifying problematic MS-DRGs.
Questions Raised About Necessity, Utility of Debarment Screening
Many providers are raising questions and concerns relating to the problems of sanction screening against the General Services Administration’s Excluded…
Medicaid Integrity Contractor Reform: MAC, MIC, ZPIC,RAC
Providers should examine workflow and procedures. They should have an appeal team organized, plan internal routing, and educate their employees…
How Can CEOs and Board Members Keep Score on Compliance Risks?
The U.S. Sentencing Commission and the Office of Inspector General (OIG) gave health care institutions a clear guide to effective…
Clarifying Sanction Screening: OIG LEIE Versus GSA EPLS
For over a decade, the OIG has been issuing “voluntary” compliance program guidance for the various health care sectors. In…
Recapping the RACs for the Upcoming Year
This article summarizes the RAC program, reviews the RACs activities in 2009, and provides guidance for dealing with the RACs…
Compliance and Program Integrity Under Health Care Reform
This article discusses the key factors to consider for compliance programs as a result of health care reform. About the…
Outsourcing Compliance in Light of Health Care Reform
To the extent that a provider or supplier does not have the necessary internal resources, getting compliance outsourcing assistance may be an appropriate…