An emerging health care compliance issue for hospitals and health systems is a potential liability under the Federal False Claims Act (FCA) based on billing for evaluation and management (“E & M”) services provided by employed physicians. Although potential liability for billing for E&M services (i.e., office visits) is not new, several recent FCA settlements should remind hospitals and health systems that the government may consider the submission of claims for E&M services under improper codes to result in a false claim. Continue reading
The Internal Revenue Service (IRS) has, for the first time, revoked a hospital’s nonprofit tax status for failure to meet the community needs assessment requirements under Internal Revenue Code (IRC) section 501(r). The hospital, which has not been identified, received a tax status letter from the IRS dated February 14, 2017 that was publicly released earlier this month. The IRS informed the hospital organization that it had failed to comply with the requirements of section 501(r) requirements to conduct a community health needs assessment, adopt an implementation strategy and make it widely available to the public. Continue reading
The Office of Inspector General (OIG) recently announced on June 15, 2017 that it will be updating the OIG Work Plan on a monthly basis rather than as it previously did once or twice a year. The OIG’s Work Plan includes several projects that the OIG’s Office of Audit Services (OAS) and Office of Evaluation and Inspections (OEI) are currently undertaking or planning to undertake in the future. The topics and focus of these projects are often indicators of potential compliance risk areas for health care providers and other participants in the health care industry. Continue reading
The waiver of coinsurance and deductibles owed by patients treated by physicians and other health care providers has come under increased scrutiny recently. Although there are no clear legal prohibitions, commercial health insurers have aggressively pursued out-of-network provides who fail to collect or waive amounts owed by their insureds under different statutory regulations.