Fraud and Abuse Compliance Information and Programs
Information topics and Frequently Asked Questions are selected from the regulations and the latest information published by State and Federal regulatory and advisory agencies and from questions received in the TMC Client Services Center.
With the increased State and Federal focus on reducing fraud and abuse in Medicare and Medicaid, healthcare practices are faced with a number of initiatives, laws and audits that can be very costly and time consuming. Fines and penalties have been increased and are more rigorously enforced. Technology is increasingly used by auditors to target activity that is inconsistent with the industry norm. Understanding the latest regulatory and enforcement activity can help you avoid problems.
TMC Fraud and Abuse Compliance Program
Radiology Referrals May Require Disclosure of Alternative Sites
CMS Self-Referral Disclosure Protocol
Are you ready for a RAC or MIC audit?
With the increased State and Federal focus on reducing fraud and abuse in Medicare and Medicaid, healthcare practices are faced with a number of initiatives, laws and audits that can be very costly and time consuming. Fines and penalties have been increased and are more rigorously enforced.
Radiologic Referrals May Require Disclosure of Alternative Sites
The final regulations on patient referrals for MRIs, CT scans PET scans, effective January 1, 2011, were published in the CMS Physician Fee Schedule for 2011. Minor changes from the proposed regulations were made as a result of public comment.
The Affordable Care Act (ACA) included a section that required a provider to give a patient a list of alternative sites when the patient is being referred for certain radiology services. The final regulations implement this law and impose specific actions.
CMS Posts Stark Law Self-Disclosure Protocol
On September 23, 2010, the Centers for Medicare and Medicaid Services (CMS) posted the Voluntary Self-Referral Disclosure Protocol (SRDP) which was required by The Affordable Care Act (ACA) enacted on March 23, 2010. The SRDP establishes a process available to all health-care providers to self-disclose and resolve actual or potential violations of the Stark Law.
