"Nationwide Healthcare Lawyers"
(November 12, 2012): The AHA Supports the Medicare Audit Improvement Act of 2012. Is this Legislation Going to Help Physicians or Not? On October 16, 2012, a new bill was introduced by Representative Sam Graves (R-MO) entitled the “Medicare Audit Improvement Act of 2012”. This legislation was immediately supported by the American Hospital Association (AHA), […]
(November 2, 2012): As we recently discussed before the East Coast arrival of Hurricane Sandy, Social Security Act Section 1135 Waivers may ultimately be available for healthcare providers in affected areas of New York, New Jersey, Delaware, New England, and surrounding states. 1135 Waivers exist to temporarily waive billing and participation requirements for healthcare providers
(October 19, 2012): This article addresses the case where an individual or “natural person” owns an interest in a Medicare health care provider which is incorporated[1] under the laws of a state, as a corporation, limited liability company, limited partnership, or another type of legal person. The individual may be a shareholder, member, limited partner,
Individual Liability for Medicare Overpayment Claims Read More »
(September 26, 2012): From the start, Zone Program Integrity Contractors (ZPICs) have worked to separate themselves from their proverbial “bounty hunter” peers – Recovery Audit Contractors (RACs). As you may know, ZPICs are paid on a contractual basis by the Centers for Medicare & Medicaid Services (CMS), instead of by how much money they return
A CMS ZPIC Contract is Quite Lucrative Read More »
(September 24, 2012): There are 3 recognized legal theories under which False Claims Act (FCA) liability may be established – the FCA Express Certification, Implied Certification, and Worthless Services theories. As you may know, the FCA is the government’s primary fraud fighting tool, and prohibits the presentation of false claims for payment by the government.
FCA Express Certification Liability Theory Read More »
(September 13, 2012): Many physicians and other health care providers around the country are reeling from post-payment and pre-payment assessments conducted by Zone Program Integrity Contractors (ZPICs). As ZPIC audits are being conducted, an issue has recently arisen regarding their independence. According to a recent report issued by the Office of Inspector General (OIG), the
HHS-OIG Finds ZPICs May Have Conflicts of Interest Read More »
(September 11, 2012): They say that “Everything is Bigger in Texas,” and its law concerning medical privacy is no exception. The Texas Legislature recently enacted the Texas Medical Privacy Act (TMPA)[1], also known as the Texas HIPAA law. The new law substantially increases the compliance burden on medical and service providers, suppliers, business associates, third
Texas Medical Privacy Act Takes Effect Read More »
(September 6, 2012): What should you do if you discover a breach of PHI (Protected Health Information). The short answer is: it all depends on who you are. With the rise in concern over and enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), patients, families, practitioners, and health care executives need
What Should I Do If I Discover A Breach of PHI? Read More »
(September 3, 2012): Zone Program Integrity Contractors (ZPICs) have turned much of their attention to prepayment review, the process by which the Medicare contractor reviews a claim for problems before it is paid. Unlike postpayment review, ZPIC prepayment review does not have an administrative appeals process, making these types of reviews incredibly damaging for a
Options for Responding if Your Practice is Placed on ZPIC Prepayment Review Read More »
(August 28, 2012): In this feature, we focus on particular Medicare audits and appeals information for various ZPIC audit and RAC audit hotspots around the country. Check back in for information about Medicare audits and appeals in your city. Medicare Audits in Miami, FL: At-a-Glance Information: Miami Population: 408,750 (2011 Census)Medicare Administrative Contractor (MAC) (Parts
Medicare Audits in Miami, FL Read More »
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