Fraud and Abuse
The Departments of Justice and Health and Human Services provided Congress with their joint “Health Care Fraud and Abuse Control Program Annual Report” outlining the healthcare fraud prevention and enforcement activities of both departments over the last fiscal year.
This article provides an overview of the recent lawsuit filed by Aetna against Bay Area Surgical Management LLC, alleging the surgery centers illegally induced its physician investors to refer their patients to the surgery centers with promises that the patients would not have any financial responsibility to the surgery centers for their out-of-network coinsurance and deductibles.
This is a hot topic for ASC’s as they should be concerned that health insurers might use aggressive litigation tactics to challenge any type of discount arrangement that the insurer does not like, even if it is designed simply to avoid the unsavory process of sending patients to collections.
Other than skilled nursing facilities, Medicare providers don’t yet face a deadline by which compliance programs will be mandatory. Here’s why providers have shouldn’t wait.
Government regulators focus on fraud and abuse in the medical transportation.
