Glossary CR – DH

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Critical Access Hospital (CAH) Fraud – these facilities are located in rural (medically needy) areas, are limited to no more than 25 inpatient beds, and are still paid on a reasonable cost basis. Questions to ask include whether the critical access hospital inflate its cost report with fictitious costs, costs not related to patient care or any other way to dishonestly increase reimbursement?

DESI (Drug Efficacy Study Implementation) Less than effective (LTE) drugs – drugs that the Food and Drug Administration (FDA) has proposed to withdraw from the market in a notice of opportunity for a hearing (NOOH) because there is a lack of substantial evidence of effectiveness for all labeled indications. Any identical, related or similar (IRS) drugs to those LTE drugs subject to the NOOH are also included in this provision. Many of these drugs have been unknowingly paid for by federal and state funded healthcare programs, although the LTE determinations were made decades ago in Federal Register notices. See also Unapproved New Drugs in this Glossary.

Designated Health Services (DHS) – in the context of Stark Law, it generally means any of the following: Clinical laboratory services: physical therapy, occupational therapy, and speech-language pathology services; Radiology and certain other imaging services (including MRI, CT and ultrasound); Radiation therapy services and supplies; Durable medical equipment and supplies; Parenteral and enteral nutrients, equipment, and supplies; Prosthetics, orthotics, and prosthetic devices and supplies; Home health services; Outpatient prescription drugs; and Inpatient and outpatient hospital services.

DHS False Claims – a violation of the Stark Law concerning Designated Health Services. See Designated Health Services in this Glossary.

DHS Fraud – a violation of the Stark Law concerning Designated Health Services. See Designated Health Services in this Glossary.