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FRAUD AND ABUSE
Where the Feds will take aim next
Based on the results of its latest annual review, the HHS Office of Inspector General has given its staff of 1,500 its marching orders to further detect fraud and abuse, in these areas:
Medical necessity. In particular, HHS will focus on psychiatric services, to determine if they're reasonable and medically indicated. The same goes for payments for polysomnography-a type of diagnostic test for patients who have a suspected sleep disorder-and claims paid under Part B for services to nursing-home beneficiaries who live a significant distance from their physicians.
E&M services. Also under the microscope in 2008 will be the number of evaluation and management services provided as part of the global surgery fee. The permissible number of E&M services may have shifted since the global surgery fee concept came about in 1992, so HHS wants to reassess things.
"Incident to" services. This area has been in the Feds' crosshairs before. Again, the government wants to review physician claims for the "incident to" services of allied health professionals-NPs, PAs, and others-to make sure they're appropriate and of sufficient quality.
One contingency a pre-nup won't cover
Well, no can do. According to the Employee Retirement Income Security Act (better known as ERISA), only a spouse can waive these rights, not a nonspouse. And, technically, a fiance is not a spouse, even if he or she signs the prenuptial agreement right before walking down the aisle, says CPA Ed Slott, a consultant to Medical Economics. The fix? Have your spouse waive his or her rights to your pension assets after the wedding.