Recent Publications
As of November 4, 2019, a new Medicare Rule known as the Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC) became effective. This Rule gives Centers for Medicare and Medicaid Services (CMS) broader authority to deter fraud by preventing certain providers and suppliers from participating in the CMS program based upon their actions and affiliations. This new rule is being phased in, and CMS has advised that it will be providing more guidance as to its implementation.
Effective January 1, 2020, a new federal overtime threshold will make millions more Americans eligible for overtime pay for working more than 40 hours per week. The federal white-collar exemption currently tied to $455 per week ($23,660 annually) will be raised to $684 per week ($35,568 annually). Any employee under the $35,000 limit will be deemed a non-exempt, hourly wage earner eligible for overtime. Further, the threshold for the exemption for highly compensated employees – which provides an exemption for well paid employees who do not meet all of the executive, administrative or professional (white collar) exemptions – has been raised from $100,000 to $107, 432.
Today, the sensationalized stories of FBI agents and criminal indictments are the day to day realities of Medicare enforcement faced by every physician. What is Medicare Fraud?
First, there are the obvious cases of greed, such as physicians billing for fictitious patients and services never performed and the rendering of unnecessary medical procedures. However, there is more to Medicare fraud than the obvious like widely practiced rule-bending to assist patients, including exaggerating either the severity of a patient’s condition, changing a patient’s billing diagnosis or reported signs or symptoms that a patient did not have, to help the patient secure coverage for needed care.
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