"Nationwide Healthcare Lawyers"
(February 24, 2015): Medicare recently finalized regulations allowing enrollment as a Medicare provider to be denied if any owner or control person of the enrolling provider is affiliated with another provider which owes money to Medicare. These regulations are based on sections of the 2010 Affordable Care Act (ACA). They provide CMS an indirect means […]
Individual Liability for Medicare Overpayment Claims Read More »
(September 29, 2014) In the last article, we discussed the importance of conducting HIPAA security risk assessments, as part of your obligations under the HIPAA Security rules. The importance of promptly conducting a risk analysis if it has not yet done cannot be overestimated, as the HHS Office for Civil Rights (OCR) has now announced
HIPAA Security Risk Assessments are Essential Read More »
(August 29, 2014) The American Cancer Society has estimated that 43.92% of all males and 38.00% of all females in the United States will develop cancer at some point during their lifetime. While a number of clinical advances have been made over the last 25 years, chemotherapy remains one of the predominant tools used to
Oncology Fraud: Michigan Oncologist Indicted Read More »
(August 31, 2014): The Healthcare Quality Improvement Act of 1986[1] (“HCQIA”, generally pronounced “Hick Kwah”), affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. Unfortunately, the provider peer review process is irrevocably
Peer Review: How HCQIA Due Process is a Fiction Read More »
(August 23, 2014): Almost all health care providers and suppliers qualify as a “covered entity” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Together with the “business associates” with whom they work, these entities are responsible for ensuring that any protected health information (PHI) under their control has been properly secured and
A HIPAA Risk Assessment is Essential to Avoid Liability Read More »
Medicare Lifts Ban on Medicare Coverage for Sex Change Surgery
Medicare Lifts Ban on Coverage for Sex Reassignment Surgery Read More »
(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative
Medicare ALJ Appeals of Denied Home Health Claims Read More »
(November 25, 2013): The link between oral health and overall health has been increasingly acknowledged over the years. Emphasis has been placed on children’s oral health in particular. In fact, the Children’s Health Insurance Program Re-authorization Act of 2009 (CHIPRA) mandates that “child health assistance provided to a targeted low-income child shall include coverage of
Is Your Dental Practice Prepared to Undergo a Medicaid Dental Audit? Read More »
(September 20, 2013): Like other physicians around the country, Texas physicians are currently facing increasing pressures to ensure that their medical necessity determinations, coverage assessments, documentation, coding and billing activities meet both Medicare’s requirements and those of private payors. While their duties and responsibilities have continued to increase, reimbursement rates have steadily fallen. Notably, Texas
Texas Medical Board Complaints are Serious Business! Read More »
Author: Ashley Morgan, Annabella Denzel (September 28, 2023): Providers participating in the Medicare and Medicaid programs are currently subject to audit by numerous Federal and State regulatory and law enforcement agencies. Additionally, the Centers for Medicare and Medicaid Services (CMS) has entered several contractual arrangements with private contractors to handle various aspects of administrative integrity