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DOJ recovered over $5.6 Billion in 2021 – Over $5B related to health care industry

On February 1, 2022, the Department of Justice (DOJ) announced on their website that they had obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending...

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Accreditation up to date? Find out on your remittance notices beginning January 3, 2022!

To supply Medicare DMEPOS to patients and to obtain and retain a supplier billing number, suppliers must adhere to the DMEPOS supplier and quality standards and accreditation requirements. In compliance with supplier standards, all changes to...

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OCR recoups over $10M in one week

By Kelli Ogunlesi, CHP, HIPAAwise Success Manager The last week of September proved to be a very busy one for the Office of Civil Rights (OCR), the federal agency responsible for enforcing HIPAA privacy and security rules. From September 21 through...

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MACs Medical Review get official start date

Today, CMS released more details on the medical review program since announcing audits would resume on August 3. This week's CMS MLN Connects newsletter included the headline "MACs Resume Medical Review on a Post-Payment Basis". In the article, it...

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More details on Medicare Audits beginning August 3

In recent meetings with CMS, we have learned that while the date to begin medical review functions is August 3rd, there will likely be a delayed time frame before audit requests officially go out. CMS is currently working to develop instructions for...

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CMS ABN form updated

CMS has updated the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131). Providers can use the new form now, and mandatory use of the form will be on 8/31/2020. The form is valid through 06/30/2023. On or after 8/31/2020, issuing an ABN...

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COVID-19 Fraud Alert

By Wayne van Halem, AHFI, CFE, President of The van Halem Group As an Accredited Healthcare Fraud Investigator and Certified Fraud Examiner, I must attend courses to obtain CEUs to maintain my accreditation and certification. I attended one last week...

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CMNs and ABNs are nearing expiration...what do you do?

By Carrie Nienberg, RN Clinical Director CMNs for Oxygen, Pneumatic Compression Devices, Osteogenesis Stimulators, Transcutaneous Electrical Nerve Stimulator (TENS), Seat Lift Mechanisms, External Infusion Pumps, Enteral and Parenteral nutrition,...

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Decoding the Standard Written Order (SWO)

On January, 1 2020, CMS made it effective that only one type of order is needed for DMEPOS claims, in an effort to help reduce supplier and provider burden. As such, the preliminary/dispensing order, Detailed Written Order (DWO), Five Element Order (5EO)/Written...

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SMRC warns 'No Response Providers' of E & M audit risk

In the SMRC's (Supplemental Medical Review Contractor) most recent current project detail for Diabetic Test Strips, they include verbiage that not only impacts the DME supplier, but also the ordering practitioner. Specifically the SMRC's current...

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