Incident-To Audit Alert

Apr 4, 2019 | Uncategorized

nnRecently the Office of Inspector General’s (OIG) website has posted cases of recent penalties that practices and providers have been charged due to incorrect billing of Incident-To. Are you at risk? The numbers are stomach turning and something that every practice should be aware of. We aren’t just talking about the huge hit in penalties, which are in the hundreds of thousands of dollars, but factor in the 15% hit you will take to your reimbursement for claims. With numbers like that it could mean a small practice having to close it’s doors.nnIncorrect submission of these claims is not something any practice aims to do. However, not submitting these claims is leaving money on the table. Read below for the enforcement actions as stipulated by the OIG and contact us today for more information.nnEnforcement ActionsnnCriminal and Civil EnforcementnThese cases often result from OIG’s work as part of its Most Wanted Health Care Fugitives initiative, the Medicare Fraud Strike Force, and other similar efforts. Since this work culminates in legal action by the U.S. Department of Justice (DOJ), links are provided to relevant news releases issued by DOJ or one of their 93 U.S. Attorneys.nState Enforcement ActionsnMedicaid Fraud Control Units (MFCU) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. Currently, MFCUs operate in 49 States and in the District of Columbia. OIG certifies, and annually recertifies, each MFCU. OIG also collects information about MFCU operations and assesses whether they comply with statutes, regulations, and OIG policy.nCivil Monetary Penalties and Affirmative ExclusionsnThe Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct.nCorporate Integrity Agreement EnforcementnThe OIG has, as a contractual remedy, the right to impose stipulated penalties for non-compliance with the requirements of a Corporate Integrity Agreement (CIA). A material breach of the terms of the CIA also may result in the provider’s exclusion from participation in the Federal health care programs.nnClick here for more information on the E&M document changes.