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5% criminal convicts

Hospitals Waste Valuable Resources Fighting Unfounded Denials by RACs (excerpt)

AIS’s Health Business Daily, February 25, 2011

Reprinted from Report on Medicare Compliance

Some compliance officers continue to fight denials from recovery audit contractors that they say defy logic, and are frustrated with the lack of feedback from RACs that hospitals could use to improve their claims submissions ….

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The Medicare Fraud Strike Force has expanded its operations to Dallas and Chicago

Reprinted from REPORT ON MEDICARE COMPLIANCE, February 21, 2011

The Medicare Fraud Strike Force has expanded its operations to Dallas and Chicago, the Department of Justice said Feb. 17.  That means the DOJ-HHS fraud fighters are now in nine cities.  DOJ also announced the largest-ever takedown with 111 defendants, who were charged for their alleged participation in schemes to defraud Medicare of $225 million.  The defendants include doctors, nurses, health care company owners and executives, and others.  Read more at www.justice.gov.

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OIG Report (excerpt)

Nursing Facilities’ Employment of Individuals With Criminal Convictions

(OEI-07-09-00110)

http://go.usa.gov/434

Our analysis of criminal history records maintained by the Federal Bureau of Investigation (FBI) revealed that 92 percent of nursing facilities employed at least one individual with at least one criminal conviction.  Overall, 5 percent of nursing facility employees had at least one criminal convictions.

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Magic Number for Medical Record Retention is 6 years, CMS Says

Medicare Compliance & Reimbursement

Eli Research Vol. 36, No. 20

If your state laws require a period longer than that, then that’s the time required, but six is the federal minimum.

Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022, issued this month.

Although many physicians follow state laws when determining whether they can discontinue retaining a patient’s records, it’s important to keep in mind that you must hang onto the patient’s records for at least six years, according to HIPAA laws.  If your state requires a period longer than that, you must extend the length of time to meet state laws, but six years is the federal minimum.

“HIPAA administrative simplification rules require a covered entity, such as a physician billing Medicare, to retain required documentation for six years from the date of its creation or the date when it last was in effect, whichever is later,” the MLN Matters article states.  “HIPAA requirements preempt state laws if they require shorter period.  Your state may require a longer retention period.”

If you submit cost reports, you must retain the original or copies for at least five years following the cost report’s closure, and Medicare managed care programs providers must retain records for ten years, the article notes.

To read the complete MLN Matters article on record retention, visit www.cms.gov/MLNMattersArticles/downloads/SE1022.pdf.

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