The health care industry is highly regulated by a variety of criminal and civil fraud and abuse laws. An effective program to ensure compliance with those laws is essential to health care providers. This session will include a discussion of current compliance “hot topics” of particular significance to providers and their advisors. The session will include the following:
• A discussion of the 60-day Medicare and Medicaid overpayment statute and CMS's corresponding 60-day rule
• An update on major court decisions interpreting the federal False Claims Act
• How enhanced data analytics and the Yates memo have changed the way in which corporate and individual violators of the fraud and abuse laws are identified, investigated, and held accountable
• The potential payment decreases associated with the CMS Evaluation and Management (E/M) proposed rules for collapsing office visits on the day of a procedure and revised documentation and coding for E/M services
• Appeals of Medicare and Medicaid contractor audits and overpayment determinations
1. Gain a better understanding of the scope of the 60-day overpayment provisions and the information that may trigger a duty to investigate potential overpayments.
2. Develop an awareness of major court decisions impacting compliance with federal laws, including the False Claims Act.
3. Understand that the government also may seek to hold individuals accountable for regulatory violations.
4. Gain an understanding of the new approach to payments for E/M services and its impact.
5. Learn strategies for responding to and appealing audits and Medicare/Medicaid overpayment determinations.