"Nationwide Healthcare Lawyers"
(May 24, 2012): The Centers for Medicare & Medicaid Services (CMS) is rolling out a new survey initiative, known as the “National Site Visit Contractor” program. In updates to the Medicare Program Integrity Manual released on April 6, 2012 and April 13, 2012, CMS has somewhat quietly introduced the National Site Visit Contractor program, noting […]
National Site Visit Contractor Established Read More »
(May 2, 2012): Recognizing that many Medicaid therapy services in the state are not in compliance with fraud, waste, and abuse laws, Tom Suehs, the Executive Commissioner for the Texas Health and Human Services Commission (HHSC), issued a reminder last week. Specifically, the Commissioner identified several violations of Texas law in recent months, most notably
Medicaid Therapy Services in Texas Must Comply With HHSC Rules Read More »
Update (May 3): In total, 107 individuals were charged yesterday in connection with a health care fraud scheme comprising $452 million in false billing. 91 of the accused have been arrested and are in custody. (May 2, 2012): News outlets are reporting that approximately 100 people have been arrested and charged with one or more
100 Involved in Health Care Fraud Arrests Read More »
(April 25, 2012): Yesterday we discussed issues surrounding returning an identified dental overpayment to Medicaid or other payors. Below is a continuation of this discussion. Dentists, oral surgeons and their staffs may ask “What types of actions might constitute an “identified” dental overpayment?” That’s a fair question, especially since the Affordable Care Act does not
Returning a Medicaid Dental Overpayment: Part II Read More »
(April 24, 2012): While considerable attention has been paid to the Affordable Care Act (generally referred to as “Health Care Reform”) and its requirement that “identified overpayments” be promptly repaid to the government, it is important to keep in mind that this repayment obligation is not new – it has long been firmly in place.
What are a Dentist’s Medicaid Overpayment Obligations? Part I Read More »
(April 23, 2012): Texas dentists, orthodontists and oral surgeons are under considerable scrutiny by the government, and most practices don’t even realize it. This article examines several one of the current tools being used by the government to calculate the alleged amount of “damages” (improper claims) paid to dental providers by the State under Medicaid.
Texas Medicaid Dental Claims Are Under Audit Scrutiny Read More »
(April 18, 2012): To be fair, when most dentists and oral surgeons think of an effective Dental Compliance Plan, it wouldn’t be unreasonable for them to think that the primary risks facing a dental practice would be limited to: Violations of the rules and regulations enforced by the Occupational Safety and Health Administration (OSHA). Violations
Components of an Effective Dental Compliance Plan Read More »
(March 21, 2012): Over the past few weeks, several important events have occurred which should have home health agencies in Texas, Oklahoma and the rest of the country rethinking the adequacy of their existing compliance efforts. The home health compliance practices of many agencies have long been a concern of the Department of Health and
Home Health Compliance Risks are a Significant Issue for Texas and Oklahoma Agencies Read More »
(March 2, 2012): Likely recognizing the enormous disparity in Administrative Law Judge (ALJ) hearing workloads for its various Field Offices, the Office of Medicare Hearings and Appeals (OMHA) recently switched to a Central Docketing System for all pending and new appeals. Under this new system, all ALJ hearing requests will be sent to OMHA’s Central
OMHA Changes ALJ Hearing Case System Read More »
(February 29, 2012): In the past few weeks, AdvanceMed Corporation, the Zone Program Integrity Contractor (ZPIC) for Regions II and V (covering the Northwestern and Southeastern portions of the United States, respectively), appears to have significantly expanded the number of Georgia prepayment reviews it is conducting. More specifically, AdvanceMed appears to be focusing on hospices,
Georgia Prepayment Reviews are Being Conducted by AdvanceMed Read More »