Compliance Pitfalls

Donna White

Donna White

By Donna White, Principal Consultant and Owner of Legacy Consulting Services and Legacy Billing Solutions in Montgomery, Alabama.

Last week there were some noteworthy cases that came through regarding compliance. This emphasizes the importance of compliance controls in every practice and what each practice needs to do to protect itself.

Unlawful Waiving of Co-Pays

It often seems like a helpful thing to do for your patients. But did you know that waiving a co-pay, co-insurance or deductible is a violation of your contract with Medicare or a commercial payor?

Lincare, Inc., one of the nation’s top oxygen and respiratory service companies, has paid $5.25 million to resolve allegations for violating the Federal False Claims Act and the Anti-Kickback Statute to Medicare beneficiaries. It is illegal to offer a reduction in contracted prices and results in the submission of false claims under the False Claims Act.

Physician Self-Referral or Stark Law Violations

Long-term care and rehabilitation hospitals group, Post Acute Medical, LLC has paid a total of $13,168,000 to resolve claims of violations of several different laws, including the False Claims Act, Stark Law and the Physician Self-Referral Law.

Stark law prevents hospitals from billing Medicare for certain services referred by providers with whom the hospital has an improper financial relationship.

The Anti-Kickback statute is pretty straightforward. This law prohibits the offer of paying anything of value (monetary or “gifts”) to encourage referral or arranging for the referral of services covered by any federally funded program like Medicare or Medicaid.

Cross-Plan Offsetting Practice

Cross-Plan Offsetting, or recoups, is a standard practice for most insurers. However, the Department of Labor has brought a complaint against UnitedHealth Group’s use of this practice, stating this violates the Employee Retirement Income Security Act.

This complaint could have a broad-ranging impact in the ways insurance companies reimburse providers.

We will continue to keep you apprised of additional litigation or developments in the coming weeks.

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