43 results.
Weighing the Stark Law Exceptions
Author: Howrey, Linda
Source: Journal of AHIMA
Publication Date: August 2008
Donations of software and services to physicians allowed under the anti-kickback exceptions are meant to spur health IT adoption, but evaluating the potential is a complex exercise for both donor and recipient.
Exceptions to the Stark Law and the anti-kickback statute enable hospital....
Voluntary Disclosure of Coding Errors and Resulting Overpayments
Author: Hayman, Russell
Source: AHIMA Convention
Publication Date: October 21, 2005
When a coding error is identified, what potential liabilities and obligations may exist, and when is repayment of any overpayment and/or disclosure of the error to the government appropriate? When providers discover the existence of coding errors and potential overpayments, they commonly ask....
Updated OIG's Provider Self-Disclosure Protocol
Author: U.S. Department of Health and Human Services. Office of the Inspector General
Source: Government (U.S.) | U.S. Department of Health & Human Services
Publication Date: April 17, 2013
This revised SDP supersedes and replaces the 1998 Federal Register Notice and the three Open Letters to Health Care Providers issued in 2006, 2008, and 2009.
Understanding HIPAA Privacy Compliance Investigations
Author: Hjort, Beth M.
Source: In Confidence (newsletter)
Publication Date: June 02, 2003
Question: Under what circumstances would our organization be investigated for HIPAA privacy compliance?
Answer: The complaint investigation process will be complaint driven. The Department of Health and Human Services’ Office for Civil Rights (OCR), the enforcement body for the privacy....
Understanding HIPAA Enforcement: Trust, but Verify
Author: Apple, Gordon J.
Source: In Confidence (newsletter)
Publication Date: June 02, 2003
Former President Ronald Reagan coined a phrase during the Cold War, “trust, but verify,” regarding treaties with the former Soviet Union. Today, as we ponder the enforcement environment likely to emerge over HIPAA, a more apt phrase may be “trust, don’t do much, and react to public pressure.”....
Understanding Governmental Audits (2013 update)
Author: Rihanek, Theresa; Lopez, Doreen
Source: AHIMA practice brief
Publication Date: November 2013
This practice brief supersedes the July 2011 practice brief "Understanding Governmental Audits."
Today, armed with enhanced fraud and abuse laws, the federal government has launched new audits that organizations and providers must contend with on a regular basis. Recent additions....
Understanding Governmental Audits
Author: AHIMA
Source: AHIMA practice brief | Journal of AHIMA
Publication Date: July 2011
This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
Trends to Watch in Home Health Compliance
Author: Abraham, Prinny
Source: Journal of AHIMA
Publication Date: May 2001
The implementation of the Home Health Prospective Payment System (PPS) on October 1, 2001, has presented some unique compliance risks for HIM and billing managers. This article will briefly describe some of the compliance-related issues on the OIG's agenda that are of interest to HIM....
Study of Health Care Fraud and Abuse: Implications for Professionals Managing Health Information
Author: AHIMA Foundation
Source: AHIMA report
Publication Date: November 2010
Stopping Fraud: Detecting and Preventing Fraud in the e-Health Era
Author: Eramo, Lisa A
Source: Journal of AHIMA
Publication Date: March 2011
Stopping fraud will require health record systems, organizations, and individuals capable of, and committed to, detecting and preventing false claims before they are paid.
Healthcare fraud continues to plague the country, costing the United States billions of dollars per year.
....
Stop Medicare Fraud [external web site]
Author: U.S. Department of Health and Human Services; U.S. Department of Justice
Source: Government (U.S.)
Publication Date: July 15, 2009
Medicare fraud results in higher health care costs for everyone. Eliminating fraud cuts costs for families, businesses, and the federal government. It also increases the quality of services for those who need care.
Roundtable Takes on Compliance Challenges
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: July 1999
The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) and the Health Care Compliance Association conducted a one-day joint roundtable on healthcare compliance to gain new insights into the challenges of creating effective compliance programs. The ro....
Room for Improvement: CMS Reports 2004 Payment Error Rate Findings; OIG Publishes Recommendations for Hospital Compliance Programs
Author: Bowman, Sue E
Source: Journal of AHIMA
Publication Date: April 2005
Two recent developments highlight the need for improvement in medical record documentation, coding, and hospital compliance programs.
CMS Fails to Meet 2004 Payment Error Rate Performance Goal
One of the Centers for Medicare and Medicaid Services’ (CMS) Medicare performan....
Quest for Interoperable Electronic Health Records: a Guide to Legal Issues in Establishing Health Information Networks
Author: Rosati, Kristen; Lamar, Marilyn
Source: External web site
Publication Date: July 02, 2005
Public Policy Discussion: Taking the Measure of the Stark Law
Author: American Health Lawyers Association. Public Interest Committee
Source: External - used with permission
Publication Date: August 10, 2009
This AHLA white paper analyzes the problems, benefits, and challenges of the Stark Law in a time of pending health care reform.
Playing a Part: The FBI's Role in Healthcare Fraud Investigations
Author: King, Ellen
Source: Journal of AHIMA
Publication Date: January 1998
Healthcare fraud is a multibillion dollar problem costing every taxpayer significant amounts of money. Fraud also jeopardizes the health and safety of patients. It has been estimated that fraud accounts for about one-tenth of the $1 trillion spent annually on healthcare.
Physician Self-Referral and Anti-kickback Laws Pose Threats to Development of Community Health Information Networks
Author: Davis Wright Tremaine LLP
Source: External - used with permission
Publication Date: October 02, 2004
[Oct. 2004] Establishing a regional community-based health information organization (RHIO) exchange presents a host of technical, regulatory, financial and practical challenges. Most would agree that in order for the regional health information organization system to be effective, community p....
OIG Compliance Program Guidance for Hospitals Update
Author: U.S. Department of Health and Human Services
Source: Federal Register
Publication Date: January 31, 2005
Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships; (Phase II); Interim Final Rule
Author: U.S. Centers for Medicare & Medicaid Services
Source: Federal Register
Publication Date: March 26, 2004
Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships; (Phase II); Correction
Author: U.S. Centers for Medicare & Medicaid Services
Source: Federal Register
Publication Date: April 06, 2004
Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships; Final Rule
Author: U.S. Health Care Financing Administration
Source: Federal Register
Publication Date: January 04, 2001
Meaningful Use Program Faces Audits, Scrutiny
Author: Rhodes, Harry B.
Source: Journal of AHIMA
Publication Date: February 2013
Health information technology systems have supported the administrative functions of healthcare for more than a decade. Historically, these healthcare administrative systems primarily focused on performing fiscal transactions or supporting key ancillary departments. Widespread use of elect....
Limitation on certain physician referrals
Author:
Source: U.S. Code
Publication Date: January 23, 2000
From the U.S. Code Online via GPO Access [wais.access.gpo.gov] [Laws in effect as of January 23, 2000] [Document not affected by Public Laws enacted between January 23, 2000 and December 4, 2001] [CITE: 42USC1395nn] TITLE 42--THE PUBLIC HEALTH AND WELFARE CHAPTER 7--SOCIAL SECURITY SUBCHAPTER XVIII....
Journal Q&A (4/03)
Author: AHIMA Professional Practice Team
Source: AHIMA Q and A
Publication Date: April 02, 2003
Q: An attorney recently told our facility that we need to retain records for at least 10 years to comply with the False Claims Act (FCA). Our state law only requires seven years. Which takes precedence?
A: The FCA (31 USC§3729–3733) applies to actions, jurisdiction, and procedu....
Journal Q&A (1/98)
Author: AHIMA Professional Practice Team
Source: AHIMA Q and A
Publication Date: January 02, 1998
Q: I am employed as a coder and am concerned about my potential risk with respect to fraud and abuse charges involving coding practices. Would you advise me to obtain professional liability insurance?
A: If you work for someone else, contact your employer's legal counsel to fi....
Journal Q&A (1/98)
Author: AHIMA Professional Practice Team
Source: AHIMA Q and A
Publication Date: January 02, 1998
Q: I am a coder in a hospital HIM department. I am being pressured to code in a manner I believe to be fraudulent in order to maximize reimbursement and improve the hospital's case mix. What should I do?
A: Always remember to exhaust all avenues for resolving the matter....
Is the FCA Effectively Fighting Healthcare Fraud?
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: May 2002
How effective has the False Claims Act (FCA) been in reducing healthcare fraud? A recent six-month study conducted by New Directions for Policy for Taxpayers Against Fraud sought to determine just that.1 What the study found is that the FCA is very effective in fighting fraud and should not be....
Health Insurance Portability and Accountability Act of 1996--Civil money penalties; investigations procedures, penalties imposition, and hearings
Author: U.S. Department of Health and Human Services
Source: Federal Register
Publication Date: April 17, 2003
Hard-line Approach to Compliance Pays Off
Author: Morris, Lewis
Source: Journal of AHIMA
Publication Date: May 2001
While the landscape will continue to change, most observers agree that the healthcare industry finds itself in a very different environment from a decade ago. The reasons for the evolution are numerous, but a significant factor has been the growing influence of compliance initiatives....
Governmental Audit Toolkit
Author: AHIMA
Source: AHIMA toolkit
Publication Date: December 02, 2011
This toolkit is designed to provide guidance to HIM professionals on how to prepare for and ensure compliance in managing governmental audits.
GAO Evaluates Implementation of False Claims Act Guidance
Author: Prophet, Sue
Source: Journal of AHIMA
Publication Date: November 1999
With the increased attention to healthcare fraud and abuse in recent years, the Department of Justice (DOJ) has been using the False Claims Act to prosecute healthcare providers for practices that, in the past, might have been dealt with by seeking repayment. The damages and penalties....
Framework For Combating Fraud, Waste, And Abuse In Federal Health Care Programs
Author: Morris, Lewis
Source: Government (U.S.)
Publication Date: April 22, 2009
Final Stark II Regulations
Author: Bergeson, Donna; Butler, Jennifer
Source: AHIMA Convention
Publication Date: October 10, 2001
Introduction
The Stark Law1is designed to prohibit physician referrals for certain services when the referring physician has a financial relationship with the facility providing the service. This paper will summarize the history of the Stark Law and provide a brief discussion of the fu....
False Claims
Author:
Source: U.S. Code
Publication Date: January 02, 2002
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between January 2, 2001 and January 28, 2002]
TITLE 31. MONEY AND FINANCE
SUBTITLE III. FINANCIAL MANAGEMENT
EHR Incentive Program Supporting Documentation for Audits
Author: U.S. Centers for Medicare & Medicaid Services
Source: Government (U.S.)
Publication Date: February 02, 2013
Cost of Fraud
Author:
Source: Journal of AHIMA
Publication Date: January 1999
According to the Department of Justice Health Care Fraud Report for Fiscal Year 1997, $1.2 billion was awarded or negotiated as a result of criminal fines, civil settlements, and judgments in healthcare fraud matters. And $517 million of that amount came from the settlements of three case....
Compliance, Medical Records, and the FBI: Preventing Fraud and Abuse
Author: Vincze, L. Stephan
Source: Journal of AHIMA
Publication Date: January 1998
The possibility of an investigation related to fraud and abuse is the last thing most people want to think about, but it's important to be prepared, just in case. The author gives some advice on how to react if your facility is the target of an investigation and points out some imp....
Compliance: A Critical Yet Costly Commitment
Author: Roach, Daniel R.
Source: Journal of AHIMA
Publication Date: May 2001
In the 1970s, the defense budget consumed the largest share of the federal budget. Concerns about both the size and efficiency of the defense bureaucracy triggered a massive crackdown on federal contractors who had either intentionally or inadvertently failed to follow the Department....
Are You Liable?: a Guide for Consultants
Author: Smith, Evan; O'Sullivan, Colleen
Source: Journal of AHIMA
Publication Date: November 2001
Based on recent civil and criminal enforcement actions, third-party medical billing companies, healthcare consultants, and medical coding personnel (collectively referred to as "consultants" throughout this article) need to be aware of potential liabilities when providing se....
Always Be Prepared, Because Challenges Never Cease
Author: Gordon, Lynne Thomas
Source: Journal of AHIMA
Publication Date: November 2014
It started with the Civil War.
When we think of the False Claims Act (FCA) today, headlines of healthcare billing fraud and abuse settlements may come to mind. But the Act actually goes back to 1863, when the US government found itself ill-served by contractors who were selli....
Advocating for Quality Documentation and Adherence to Official Coding Guidelines
Author: AHIMA House of Delegates
Source: Journal of AHIMA | AHIMA HoD Resolution
Publication Date: January 1998
Background
In August 1996, the Health Insurance Portability and Accountability Act (HIPAA) [Public Law 104-191] established the infrastructure and funding for federal fraud and abuse efforts. This legislation authorizes the appropriation of $104 million in 1997, with increases in....
ABNs--Always Been Neglected
Author: Dunn, Rose T
Source: AHIMA community resource
Publication Date: November 14, 2003
For something that has been around for nearly 2 decades and supported by regulation since 1965, Advance Beneficiary Notices (ABNs) continue to cause headaches today. The use of written notices has been available since the enactment of PL 92-603 in 1972. The specific format called an Advance B....
2003 Red Book Reveals Cost-saving Recommendations
Author: Prophet-Bowman, Sue
Source: Journal of AHIMA
Publication Date: September 2003
Although the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has already saved tax payers more than $12 million this year, it offers still more cost-saving recommendations for the Centers for Medicare & Medicaid Services (CMS) in its annual Red Book that hav....