Medicaid Compliance Strategies for Hospitals, Health Systems and Other Providers

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As CMS and the HHS Office of Inspector General ramp up efforts to curtail Medicaid payment errors and fraud and abuse, Medicaid needs to be a top focus for every hospital compliance officer.

Medicaid Compliance Strategies for Hospitals, Health Systems and Other Providers focuses on various Medicaid compliance issues and initiatives mandated by state and federal enforcing and monitoring agencies. It also provides advice on steps health care compliance officers can take to limit their risks in this area of growing concern.

This practical report is filled with articles and sample policies that examine the problems, and successes, providers are facing in Medicaid compliance – in areas such as the Deficit Reduction Act (DRA), the False Claims Act (FCA), Medicaid Fraud Control Units (MFCUs), Payment Error Rate Measurement (PERM) and more.

Gain insights into how to react to tough new congressional mandates and intense pressure from the states. Order your copy of Medicaid Compliance Strategies for Hospitals, Health Systems and Other Providers today!

• Providers Said to Be Confused About Education Provisions Under DRA
• Multistate Providers Face Problems Complying With DRA Requirements
• DRA Education: One Provider’s Approach
• Tracking, Reporting NDC Would Be Huge Financial Burden on Hospitals
• Under DRA, HHS Awards $52 Million to States
• New CMS Rule Clarifies What Constitutes Medicaid TCM Services
• DRA Has Strengthened States’ Recourse Against Third Parties

• With Potential Hike in FCA Lawsuits, Providers Must Enhance Compliance
• Merck to Pay More Than $650 Million to Settle False Claims Act Suits
• Dentists Who Put 16 Crowns in Some Kids Settle for $10 Million

• University Makes Progress Under DPA, According to Federal Monitor
• Mental Health Group Pays $1 Million In Alleged Medi-Cal Billing Fraud Settlement
• Feds Terminate DPA With UMDNJ, Will Dismiss Complaint for Fraud
• Pennsylvania Nursing Home Facing Medicaid Fraud Charges Enters Into Consent Order
• Doc Pleads Guilty to Fraudulent Billing; Claims Rules Are Complex
• Brothers Get Different Sentences In N.J. Medicaid Fraud Case
• Nursing Homes Get Intense Medicaid Scrutiny; Feds Use Multiple Statutes
• Two States Require Documentation From Ambulette Service Providers

• State MFCUs Recover Record Medicaid Amounts, OIG Report Says
• R.I. MFCU Recovers $589,310 in Settlement
• S.C. MFCU Raids Ambu-Star Offices
• Maryland Couple Found Guilty in Fraud Case Brought by MFCU

• CMS Gears Up for Medicaid Audits, Awards Contracts
• MIP Auditors Hit Four States; 60-Day Rule Creates Tense Recoupment Dynamic
• CMIP Gives Integrity Program Agenda, Goals for Next Five Years
• ‘MICs’ to Target Payment Rules, Public Hospitals; More Medicaid Letters Coming
• Single Medicare/Medicaid Enrollment Form Is in Works in New Integrity Initiative
• ‘MMedical Necessity, Credentials Are Expected Targets of Medicaid Mental Health Audits

• In N.Y., Sheehan Revs Up Medicaid Machine; Mandatory Compliance Programs to Come
• New York State Exceeds Target in Savings From Medicaid Enforcement
• In First State Medicaid Work Plan, Sheehan Details Audit Targets, CIAs, Self-Disclosure
• State/County Medicaid Task Force Nets First Guilty Pleas in Crackdown on HHAs

• AFG Achieves 54% Enrollment in First-Year
• Zions Bank Employees Enroll in HSA-Based Plan

• States Advise Providers to Comply With PERM Audit Contractors
• Providers Need to Be Ready for Onslaught of Federal and State Medicaid Enforcement
• High Preliminary PERM Error Rate Doesn’t Reflect Medicaid As Whole, CMS Says
• High Amount of Improper Medicaid Payments Will Lead to Increased Scrutiny, Enforcement

• Medicaid Compliance News
• Report on Medicare Compliance

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