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(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct (additional arrests were made in the days following the takedown). As Attorney General Jeff Sessions stated at […]
Pain Management Prescribing Practices and Audits. Read More »
(June 30, 2017): In March 2016, the Centers for Disease Control and Prevention (CDC) published “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016” [1] in an effort to address the seemingly ever-increasing deaths that have been attributed to opioid-related overdose. A number of states have passed legislation or enacted regulatory provisions
Maryland Limits on Opioid Prescriptions Read More »
(June 29, 2017): Deaths resulting from a drug overdose have grown considerably in recent years. The results of a study published in “Morbidity and Mortality Weekly Report” by the Centers for Disease Control and Prevention (CDC) found that 63.1% of the overdose-related deaths in 2015 involved opioids. Notably, this was a significant increase from the
Indiana Opioid Prescribing Guidelines–Eff. July 1, 2017. Read More »
(June 29, 2017): It has been estimated that from 1999 to 2014, more than 165,000 persons died from an overdose of opioid medications in the United States. Researchers also noted that during this same time period, sales of opioids increased in proportion to the rise in deaths resulting from an opioid-related overdose. In an effort
Opioid Prescribing Practices & NBI MEDIC / UPIC / ZPIC and Board Actions Read More »
(June 28, 2017): The Medicare program is enormous. As of 2016, more than 56 million individuals participated in the program, with more than 10,000 additional individuals enrolling in the program each day. The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for managing this costly program. To direct this $640 billion program,
NBI MEDIC Referrals to Boards, OIG and DOJ are Here! Read More »
(June 23, 2017): Opioid audits of the prescribing practices of pain management physicians are on the rise. As the Department of Health and Human Services (HHS), Office of Inspector General (OIG), noted in its report “High Part D Spending o Opioids and Substantial Growth in Compounded Drugs Raise Concerns,” 30% of Medicare beneficiaries have at
UPIC / ZPIC / Health Integrity Opioid Audits and Audits of Other High Risk Drugs. Read More »
(June 21, 2017): Over the last year, the False Claims Act penalties have almost doubled. This is especially important when you consider the fact that the False Claims Act is the primary civil enforcement tool used by the U.S. Department of Justice to fight fraud committed against government programs by individuals and entities. Often referred
False Claims Act Penalties Have Almost Doubled! Read More »
(June 20, 2017): As the Department of Health and Human Services (HHS), Office of Inspector General (OIG), signaled in both its 2016 and 2017 Work Plans, the government is concerned about the rapid growth they are seeing in the number of physician home services billed to the Medicare program. In order to qualify for coverage
Medicare Home Services (CPT® codes 99341-99350) are Being Audited Read More »
(June 16, 2017): Under the Social Security Act, states are required to operate a Medicaid Fraud Control Unit (MFCU).[1] Each MFCU is tasked with the investigation and prosecution (under state law) of Medicaid providers who engage in fraud or patient abuse. Last year was rough for dentists participating in the Medicaid program. As set out
Medicaid Dental Audits of IV Sedation Services Read More »
(Updated March 20, 2020): Historically, the Centers for Medicare and Medicaid Services (CMS) has relied on a network of private contractors to handle the program integrity functions for both the Medicare and Medicaid programs. Over the years, these private contractors have taken on increasingly significant roles in the detection and audit of instances of fraud,
UPIC Claims Audits of Medicare Services are Underway! Are You Ready? Read More »