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At least 649 records · Page 36Linked to original sources
PubMed1998

Budget battle looms. Clinton uses fraud fines, user fees to pay for programs.

President Clinton ignited a new money battle for providers last week as he proposed an activist healthcare agenda in his proposal to balance the federal budget in the next fiscal year. In his $1.733 trillion fiscal 1999 spending plan, Clinton proposed that providers and health plans pay $659.2 million in new user fees to fund expanded provider audits, certification surveys and a host of other HCFA activities.

Budgets↗
PubMed1998

How provider fraud flattens corporate profits.

New laws are giving the private sector some real enforcement clout--and a better shot at recovering or preserving huge sums of money at a time when other dampers on costs are screwed down about as tight as they can get.

Cost Savings↗
PubMed1998

Health care programs: fraud and abuse; revised OIG civil money penalties resulting from the Health Insurance Portability and Accountability Act of 1996--Office of Inspector General (OIG), HHS. Notice of proposed rulemaking.

This proposed rule would revise the OIG's civil money penalty (CMP) authorities, in conjunction with new and revised provisions set forth in the Health Insurance Portability and Accountability Act of 1996. Among other provisions, this proposed rulemaking would codify new CMPs for: Excluded individuals retaining ownership or control interest in an entity; upcoding and claims for medically unnecessary services; offering inducements to beneficiaries; and false certification of eligibility for home health services. This rule would also codify a number of technical and conforming changes consistent with the OIG's existing sanction authorities.

Eligibility Determination↗
PubMed1998

Fraud and abuse. Understanding the Stark II proposed regulations.

HCFA's recently published proposed regulations for implementing Stark II legislation have significant implications regarding Medicare and Medicaid payments for physician referrals, and likely will be the most extensive governmental guidance available on the Stark laws. While final regulations will not be issued for some time, the availability of the guidance provided by these expanded definitions increases the risk that the government will increase its antifraud and abuse activities, particularly with respect to those aspects of the statutes that were previously unclear. Physicians and hospitals should become familiar with the new definitions of designated health services for which self-referrals are prohibited, particularly inpatient and outpatient hospital services, whose inclusion as designated health services significantly expands the scope of the Stark prohibitions to many common hospital/physician transactions. They also should begin to lay plans to ensure compliance with the new regulations and to map cut strategies for revising existing organizational structures and financial arrangements.

Ambulatory Care↗