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Retrieving Billions in Overpayments by CMS

Healthcare IT Today

Challenges of Investigating Overpayments Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). How can such overpayments be uncovered? public in overpayments. But the needles pile up fast.

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Updated Compliance Program Guidance for Nursing Facilities

Compliancy Group

The Office of Inspector General (OIG) released an updated Nursing Facility Industry Compliance Program Guidance (ICPG) in November 2024 to assist nursing facilities in navigating the complex regulatory landscape and mitigating compliance risks. The ICP covers the areas listed below.

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Breaking Down the OIG’s First Industry-Specific Guidance 

YouCompli

This first ICPG covers Skilled Nursing Facilities and Nursing Facilities. Quality of Care and Quality of Life For decades, the OIG and other government enforcement agencies have emphasized the importance of the quality of care and quality of life for nursing facility residents. Lets review some of the highlights.

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New York Medicaid Providers Now Have Two Pathways to Self-Disclose Overpayments to the Office of the Medicaid Inspector General

Healthcare Law Blog

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.

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Home health agencies make legal case against CMS' proposed cuts

Modern Healthcare

CMS could consider a policy more like the one it used to correct for overpayments to nursing homes, home health leaders said.

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Georgia Nursing Home Settles to Resolve Allegations of False Claims for Therapy Services

Healthcare Compliance Blog

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

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Avoiding Red Flags: Finding the Right Productivity Balance

Healthcare IT Today

The payer could also recoup the overpayments from future visits. . John Wallace, PT, MS, has more than 35 years of experience in private practice orthopedics as well as acute hospital, acute rehab, home health care, skilled nursing, sub-acute care, and sports medicine. About John Wallace.