Your Government at Work

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ACHC Approved for Recognition as ESRD Accrediting Organization

The Centers for Medicare & Medicaid Services issued a final notice announcing its decision to approve the Accreditation Commission for Health Care, Inc. (“ACHC”) for recognition as a national accrediting organization for End Stage Renal Disease (“ESRD”) facilities that want to participate in Medicare or Medicaid.  CMS’s approval is effective April 11, 2019 through April 11, 2023.

OIG Conducts Nationwide DME and Telemedicine Fraud Takedown

The Department of Health and Human Services Office of Inspector General (“OIG”), in partnership with the Department of Justice and other law enforcement agencies, announced that it had conducted a nationwide fraud takedown of an alleged scheme that involved durable medical equipment (“DME”) companies allegedly paying medical professionals working with fraudulent telemedicine companies to refer Medicare beneficiaries for medically unnecessary orthotic braces.  This alleged scheme involves more than $1 billion in losses and has resulted in charges against 24 defendants, including CEOs, COOs and others associated with a number of telemedicine companies, the owners of dozens of DME companies, and three licensed health care professionals.  More information can be found here.

OIG Updates Its Work Plan

The OIG has made updates to its Work Plan.  The OIG Work Plan summarizes new, ongoing, and revised areas of review that the OIG plans to pursue.  The OIG updates this Work Plan each month in order to enhance transparency of its continuous work planning efforts.  These latest updates include reviews of post-hospital care provided by skilled nursing facilities to dually eligible beneficiaries, select state Medicaid agency payments to hospitals via uncompensated care pools, monthly ESRD-related visits billed by physicians and other qualified health care professionals, and the impact of price substitutions based on 2017 average sales prices on Medicare Part B drug payments.

 

The Joint Commission at Work

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The Joint Commission Updates Its Standards FAQs

The Joint Commission has updated the Frequently Asked Questions portion of its website to answer a question about focused professional practice evaluations (“FPPE”).  Specifically, the new Standards FAQ addresses whether the FPPE process must be pre-defined for new privileges or if that process can be determined for each specific applicant.  More information can be found here.

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