Dear Colleagues,

Hospital Pricing Specialists just learned that the Department of Justice (DOJ) charged 86 defendants across 16 federal districts for up to $4.5 billion in telemedicine fraud (see DOJ Statement from 9/30/20)

The billions in false claims were submitted to both public and private insurers, the DOJ said.

In some cases, telemedicine executives would induce physicians to prescribe medical devices, testing or prescription drugs that were not medically necessary after a brief phone call, with fraudulent claims then submitted to Medicare and other government payers, court documents say.

Alongside the fraud takedown, the Centers for Medicare & Medicaid Services (CMS) said it would revoke Medicare billing privileges from 256 medical professionals in connection with telemedicine fraud.

Speaking of government regulations and oversight, let's switch to the new price transparency rules, effective 1/1/21. 

Unfortunately, we are not accepting new clients at this time with the guarantee that we can meet the full requirements by the 1/1/21 deadline. If you have an unsigned Services Agreement with us, it must be returned by next Wednesday, 10/7/20, or the Agreement will expire.

If you're not already signed up with us to meet the new requirements, we are accepting new clients with the condition that by 1/1/21 we will have a patient price estimator tool and machine-readable file available on your website.  However, we can not guarantee that it will meet our highest standards (we are former CMS RAC Auditors) given our limited time to meet the deadline.  For "late bird" clients, we will continue to refine the deliverables past the 1/1/21 deadline until they meet our highest standards.

We're just being honest.  There are many vendors who simply want your money and do not fully understand all of the complexities involved to fully meet the new requirements, especially the machine-readable file.  In order to fully appreciate the new price transparency requirements, I suggest you watch a HFMA webinar that HPS presented last month [HERE].

If you'd like to discuss anything on this email, you can schedule a meeting on my private calendar:


Rick Louie
Managing Director
Hospital Pricing Specialists LLC

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