Program Integrity

Apr 12, 2018
On April 9, the Centers for Medicare & Medicaid Services issued a final rule and related guidance that will implement the standards governing health insurance issuers and the Health Insurance Marketplaces for 2019. In the rule, CMS provides details on the benefit and payment parameters for…
Oct 24, 2017
Infographic: Federal Agencies with Regulatory or Oversight Authority Impacting Hospitals
  ​ ​         Add this infographic to your web site by copying the code below. Share this with your friends! <p><a href="https://www.aha.org/system/files/2018-01/info-regulatory-burden-federal-agencies.pdf"><img src="https://www.aha.org/sites/…
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Program Integrity

Oct 17, 2017
Hospitals take seriously their responsibility to help combat waste, fraud, abuse and payment errors in federal health programs.
In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments. These audit contractors include recovery audit contractors (RACs) and Medicare administrative contractors (…
Sep 20, 2017
AHA comments on the Health Resources and Services Administrations interim final rule that would further delay the effective date for the implementation of the Affordable Care Act provision requiring a 340B Drug Pricing Program ceiling price calculation methodology and application of civil monetary penalties for violations of the ceiling price.
Jan 17, 2017
The HHS Jan. 13 issued a final rule that makes changes to the procedures for Administrative Law Judge appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals.
Jan 12, 2017
The Department of Health and Human Services’ Office of Inspector General today issued a final rule expanding its ability to exclude individuals or entities from federal health care programs, as authorized by the Affordable Care Act and other laws. The rule allows OIG to exclude individuals or…
Nov 14, 2016
Beginning Dec. 1, the CMS will reopen settlement for certain inpatient status claims.
Jun 29, 2016
The Department of Health and Human Services late June 28, issued a proposed rule that would make changes to the procedures for Administrative Law Judge (ALJ) appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare…
Jun 16, 2016
Supreme Court issues decision in False Claims Act case.
Feb 24, 2016
CMS Feb. 11 issued a final rule implementing a provision in the Affordable Care Act.