"Nationwide Healthcare Lawyers"
(June 5, 2017): Despite the fact that only three treatment services are covered by Medicare, the number of Medicare chiropractic audits conducted by the Department of Health Human Services (HHS), Office of Inspector General (OIG), has remained high over the last decade and is anticipated to grow throughout 2017 and 2018. As you are aware, […]
Medicare Chiropractic Audits are Increasing! Read More »
(May 26, 2017): Over the past decade, the number of patients utilizing one or more complimentary or alternative care modalities has steadily increased. As patient demand for such services has grown, the percentage of payors including acupuncture in their plans as a covered service has also increased. For over a decade now, most private payor
Private Insurance Payors are Aggressively Conducting Acupuncture Audits Read More »
(May 17, 2017): Exclusion screening-OIG screening duties are now more important than ever before! The recently issued Resource Guide for Measuring Compliance Program Effectiveness” a product of Office of Inspector General staff and compliance professionals roundtable discussions, reconfigures the traditional “Seven Elements of an Effective Compliance Program” by making the “Screening and Evaluation of Employees, Physicians,
Exclusion Screening-OIG Screening: The New “Seventh Element” of Compliance. Read More »
(May 15, 2017): Over the last decade, both state and federal law enforcement agencies have aggressively investigated and prosecuted instances of Medicaid dental fraud. In recent years, these efforts have been widely implemented (and expanded) by private payor Special Investigative Units (SIUs). One dental benefits program in particular has been especially active in this regard
Delta Dental Audits are Ongoing Around the Country. Are You Prepared? Read More »
(March 29, 2017): The Centers for Medicare and Medicaid Services (CMS) has recently published a new Final Rule that makes changes to the Conditions of Participation for home health agencies. Under the Final Rule, providers are required to ensure that individuals and entities providing services under arrangement are not excluded, terminated, or debarred from any
Home Health Final Rule Creates New Exclusion Screening Obligation Read More »
(January 9, 2017): As the Centers for Medicare and Medicaid Services (CMS) has announced, the alleged error rate associated with home health claims has risen from 17.3 % in FY 2013 to 51.38% in FY 2014 and 58.95% in FY 2015. In light of these increases, CMS has taken steps to address the home health
Home Health: Pre-Claim Review Demonstration Project Read More »
(January 9, 2017): A recent report of the New York State agency that administers the Medicaid program by the Department of Health and Human Services, Office of Inspector General (OIG) further highlights the importance of ensuring that dentists providing services to Medicaid beneficiaries are properly licensed, enrolled as a Medicaid provider and not excluded from
Medicaid Dentist Eligibility Audits are Ongoing Around the Country Read More »
(October 11, 2016): More than 45 million children receive government-funded dental care served under Medicaid and CHIP programs. This equates to approximately 1 out every 3 children in the country. The dental care provided includes screening services and other preventive, diagnostic, and treatment services that are medically necessary and properly documented. Under the mandatory Early
Dental Practice Audits are on the Rise — Protect your Interests! Read More »
(September 20, 2016): On August 3, 2016, the Centers for Medicare and Medicaid Services (CMS) implemented its “Pre-Claim Review Demonstration” project in Illinois. This demonstration project effectively requires that Illinois home health agencies submit home health claims for review by the Medicare Administrative Contractor (MAC) or face possible penalties (and be forced to have the
Home Health Pre-Claim Review Demonstration Project Update! Read More »
(August 23, 2016): During 2014, the Texas Health Human Services Commission’s (THHSC), Office of Inspector General (IG) found itself at the center of a number of controversial investigations and probes associated with its review of Medicaid dental claims. In response, Governor Greg Abbott appointed Stuart W. Bowen, the former Inspector General for Iraq Reconstruction to
More Texas Medicaid Dental Audits Are Coming in 2017! Read More »