New Medicare Fraud Strike Force Activity Leads to Charges for Large California Ambulance Service; Houston Mental Health Facility

The United States Department of Justice today unveiled charges against a total of 91 individuals in 7 different locations for allegedly fraudulent activities that allegedly cost Federal healthcare programs in excess of 535 million dollars. The highlights for EMS providers and Texas: Alpha Ambulance Inc. (Los Angeles, CA): Approximately $49.2 million in fraudulent billing ...

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New HHS OIG Work Plan – Same Old Stuff for Ambulance Services

The Office of the Inspector General for the Department of Health and Human Services issued the FY 2013 Work Plan today.  The Work Plan only has one specific reference to Ambulance Services; basically it is a repeat of last year's offering: Ambulances—Compliance With Medical Necessity and Level-of-Transport Requirements We will examine Medicare claims ...

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HHS OIG Issues Advisory Opinion Regarding ALS Billing by BLS Ambulance Companies

The Department of Health and Human Services Office of the Inspector General issues an new advisory opinion today, No. 12-12, which addresses the billing of ALS services by a BLS level ambulance service.  The opinion, signed by Greg Demske (full disclosure: I know Greg personally from the ABA ...

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Trailblazer-Novartis Transition News: EFT Enrollees Need to Pay Attention to Mail to Avoid Payment Issues

Novartis has circulated an email warning Medicare providers in the MAC regions currently covered by Trailblazer that they need to pay attention to the mail regarding an issue with Electronic Funds Transfer.  Apparently, Novartis is required to obtain updated Authorization Agreements for EFT's during the transition, and if they don't receive ...

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I’ve Received a Subpoena from the Feds . . . Now What? Part 2

Obviously today is not Thursday . . . but I am back today with the follow-up post. In Part 1, I discussed the initial steps if you get a subpoena from a government agency.  Today, what are your obligations if you received a subpoena? First, let your attorney (OK, if you did not get that ...

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If Congress Says No Judicial Review, They Mean No Judicial Review – Sayeth the Fifth Circuit

The United States Fifth Circuit Court of Appeals issued a ruling Friday in Paladin Community Mental Health Centers v. Sebelius, a case out of the Western District of Texas.  Basically, the ruling holds that if Congress says No Judicial Review, then they mean no judicial review . . . except within some very narrow circumstances, ...

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New OIG Advisory Opinion Regarding Ambulance Services – No. 12-07

I will start out by making the following statements: This one is pretty obvious.  While you might be able to make a case under a really strict reading of the rules, this doesn't come close in terms of creating an issue of a kickback, in my opinion; and I like Greg Demske's style  of writing these Advisory ...

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I’ve Received a Subpoena from the Feds . . . Now What?

Based on the recent activities of the HEAT strike teams in Texas (see here, here and here) , I would anticipate that many ambulance and other small healthcare providers may be getting subpoenas in the near future.  What should you do if you receive a subpoena from any government agency? This should ...

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From Trailblazer – Submitting Medical Records on CD/DVD

Trailblazer is making at least a small move to kill a few less trees this year - they are accepting supporting documentation on a CD or DVD disk.  There are some formatting requirements (see the link below to the jobaid for the procedure from Trailblazer), so pay attention to the requirements. The text of the ...

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Trailblazer is at it Again: Auditing Emergency Room Services

I'm not going to cross post the whole thing, but I direct you to this post on my Texas Nursing Law blog.  Read it carefully and see if it sounds familiar . . . the 98% error rates from the scheduled transport notices were extremely similar.  Why does Trailblazer think that if Physicians ...

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