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Avoiding Medicare and Medicaid Fraud and Abuse

Avoiding Medicare and Medicaid Fraud and Abuse

Recently the U.S. Department of Health and Human Services, Office of Inspector General released a new publication booklet, “Avoiding Medicare and Medicaid Fraud and Abuse.”In its publication, the Government agencies (Department of Justice, the Department of Health and Human Services, Office of Inspector General, and the Centers for Medicare and Medicaid Services) outlined five of the most important federal laws affecting physicians’ offices. The Office of Inspector General recommends that physicians frequently conduct self-audits. In an effort to help with your recommended self-audits, I have provided a synopsis of the five most prevalent federal laws affecting our offices:

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Treating Employees in the Office

Treating Employees in the Office

This is an activity that falls in the “not specifically prohibited” category but is still fraught with pitfalls. In the first place, you have the same duty of care to an employee as you would toward any patient, and you should only perform procedures within your competency. The fact that the individual is your employee does not justify trying a new procedure in which you have no experience. Secondly, consider that if the employee becomes dissatisfied with treatment, it may lead to both a malpractice complaint and employment-related complaints as well.

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Medical Necessity Requirements

Medical Necessity Requirements

On December 23, 2015, the Centers for Medicare and Medicaid Services (CMS) released a new instructional video describing their policies and procedures for establishing the medical necessity of chiropractic care.1 The video was released on the heels of a new study released by the Office of Inspector General (OIG), “CMS Should use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services”2, which revealed extrapolated data suggesting fraud and abuse in chiropractic Medicare utilization.

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HIPAA Compliance

HIPAA Compliance

A couple of weeks ago, I received a phone call from one of our clients in obvious distress. He indicated that his server had crashed and low and behold, both of his backups also failed. Not only did he lose three years worth of electronic patient records, but every patient’s billing information, payments, and accounting. He was obviously the most worried about what would happen if any insurance carrier were to ask for records during this period of time. Little did he know, this was only the beginning of his nightmare.

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