What's New

October 16, 2020

Cedars-Sinai Medical Center: Audit of Medicare Payments for Bariatric Surgeries A-09-18-03010

October 15, 2020

Updated: Work Plan

October 13, 2020

Medicare Improperly Paid Physicians for More Than Five Spinal Facet-Joint Injection Sessions During a Rolling 12-Month Period A-09-20-03003

October 9, 2020

Update on Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic A-09-20-01000

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Enforcement Actions

October 20, 2020; U.S. Attorney's Office, District of New Jersey

Medical Assistant Admits Role in Genetic Testing Kickback and Bribery Scheme

October 20, 2020; U.S. Attorney's Office, District of Maryland

Former Department Head at Walter Reed National Military Medical Center Pleads Guilty to Federal Charges in Maryland for Accepting Gratuities: Public Official Received Money, Travel, and Sporting Event Tickets From A Maryland Company Receiving Over $25 Million in Government Business

October 16, 2020; U.S. Attorney's Office; Western District of Texas

Federal Grand Jury in San Antonio Indicts Two in Health Care Fraud Scheme

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What's Trending

1. Medicare Improperly Paid Physicians for More Than Five Spinal Facet-Joint Injection Sessions During a Rolling 12-Month Period
2. Incorrect Acute Stroke Diagnosis Codes Submitted by Traditional Medicare Providers Resulted in Millions of Dollars in Increased Payments to Medicare Advantage Organizations
3. Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials
4. COVID-19 Portal
5. Medicare Outpatient Outlier Payments for Claims With Credits for Replaced Medical Devices