The U.S. Department of Justice (DOJ) published an interim final rule on June 30th that dramatically increased potential civil penalties under the Civil False Claims Act and the Federal Anti-Kickback Statute. Currently, violations of the …..
The Louisiana Department of Health (LDH) published two notices of intent in the July 2016 edition of the Louisiana Register related to free-standing emergency departments (EDs). One proposed rules would prohibit free-standing EDs from operating …..
Quantification Required as Part of “Identifying” and Overpayment Six years after issuing its Proposed Rule, CMS released its final 60-Day Rule for reporting and returning overpayments. The Final 60-Day Rule is more industry-friendly, but still …..
Patients admitted to a partial hospitalization program (PHP) must be under the care of a physician who certifies the need for partial hospitalization and that the patient requires a minimum of 20 hours per week …..
For the first time since HIPAA was enacted in 1996, vendors and other business partners such as law firms and billing companies who handle health information on behalf of healthcare providers can be held directly …..
CMS recently provided direction to A/B MACs and QICs regarding the scope of appellate review for redetermination (1st Level) and reconsideration (2nd Level) appeals of certain claims. Historically, MACs and QICs had discretion while conducting …..
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