◆ Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional period of enhanced oversight,” according to a July MLN fact sheet.[1] “Over the last 12 months, we’ve received numerous reports of hospice fraud, waste, and abuse. The number of enrolled hospices has also increased significantly in these states, raising serious concerns about market oversaturation.” The enhanced oversight involves medical review (e.g., prepayment review).
◆ Dermatologist, John Y. Chung, M.D., and his practice Skin Cancer & Cosmetic Dermatology Center P.C. (SCCDC)—which includes 13 dermatology clinics in southeast Tennessee and north Georgia—have agreed to pay $6.6 million to settle false claims allegations over billing Medicare, Medicaid and other federal health care programs for Mohs micrographic surgeries and other dermatological procedures, the U.S. Attorney’s Office for the Eastern District of Tennessee said July 13.[2] Chung and SCCDC allegedly submitted false claims for Mohs procedures that were billed as if both the surgery and pathology portions were performed by Chung, when at least one portion was often performed by someone else, from 2010 through 2020. The settlement also settles allegations that SCCDC billed Medicare “for multiple procedures performed on the same patient on the same day, in a manner that improperly circumvented Medicare’s multiple procedure reduction rule.” Chung and his practice didn’t admit liability in the settlement.