tci Medicare Compliance & Reimbursement - 2003 Issue 35

Fraud & Abuse: OIG EYES EXCESSIVE CHARGES

Clarification may be in store on what could get providers excluded from Medicare.  Providers confused about how much is too much when it comes to charge-based Medicare payments could soon get some guidance from the HHS Office of Inspector General. In a Sept. 15 Federal Register notice, the OIG says it's planning to clarify the regulations that govern when it can exclude a provider from Medicare and other federal health care programs for billing for amounts that are substantially in excess of its usual charges. The proposal includes a formula that defines "usual charges" as well as a...

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