HCPro.com: Healthcare Auditing Weekly

This weekly email newsletter offers health care internal auditors and compliance professionals the latest information on setting up and maintaining an effective auditing program.

July 1, 2008 (Volume 6, Issue 25)

State claimed ineligible drugs for Medicaid reimbursement
In fiscal years 2003 and 2004, Missouri claimed $2.09 billion ($1.33 billion in federal share) for reimbursement of Medicaid outpatient drug expenditures. However, the OIG found that the state did not fully comply with federal requirements.

OIG releases MFCU annual report for FY 2007
In the Medicare Fraud Control Units annual report for fiscal year 2007, the OIG found that MFCUs recovered $1.1 billion in court-ordered restitution, fines, civil settlements, and penalties.

Tip: Use data analysis to identify potential fraud and abuse
Data analysis is an excellent tool for identifying potential fraud and abuse. Data analysis is the comparison of claim information and other related data to identify potential errors and/or potential frauds by claim characteristics individually or in the aggregate. Use these helpful methods and techniques to get the most out of data analysis:

Featured Audit Plan: Physician practice - provider-based entity model
Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans" section of the Healthcare Audit Resource Center, the home of dozens of audit plans.

Other recently-published articles from Healthcare Auditing Weekly:

Tip: Using questionnaires

Maine Medicaid pays $600,000 in overpayments due to computer error

OIG: Medicare overstated fraud recoveries

Tip: Six questions to ask when evaluating a hospital’s response to detected deficiencies

More providers will stop paying for never events

State Medicaid agencies fail to report inadequate providers to OIG

Tip: A four-step planning process for rapid compliance program development

California men accused of using homeless for fraud

Stark Law changes effective October 2008

Tip: Use Compliance Guidance to help with billing and coding

New Jersey pays for Medicaid beneficiaries living in New York

CMS adds more never events to list of uncovered conditions

Featured Audit Plan: Physician Practice - Coding

Tip: When determining compliance policies and procedures, follow the OIG’s guidance for compliance programs

Gift cards do not violate Anti-kickback Statute

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