"Nationwide Healthcare Lawyers"
(May 15, 2012): Recent efforts by CMS to improve the performance of Medicaid MIC audits have resulted in procedural changes for these contractors and new financial incentives for Medicaid Recovery Audit Contractors (MRACs). These new procedural changes are intended to improve the effectiveness of MRAC audits. The recent U.S. Department of Health and Human Services […]
Medicaid MIC Audits to Increase 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 11, 2012): At a conference last week in Baltimore, Angela Brice-Smith, Acting Director of the Centers for Medicare & Medicaid Services (CMS) Medicaid Integrity Group, stated that 26 states have awarded contracts under the Medicaid RAC program, and a quarter of those states’ Medicaid RACs are now reviewing claims. Ms. Brice-Smith added that CMS
Medicaid RAC Program Up and Running – 26 States Award RAC Contracts 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 »
(February 22, 2012): The proper handling of Medicare overpayments is an essential responsibility of all participating providers. Late last week, the Centers for Medicare & Medicaid Services (CMS) released an important proposed rule in the Federal Register that could dramatically affect all healthcare providers, Third-party billers and other entities involved in the healthcare industry. The proposed rule,
CMS Issues Proposed Rules About Returning Medicare Overpayments Read More »
(February 7, 2012): In recent years, physicians and other health care providers have faced a wide number of administrative actions and sanctions levied by contractors working for the Centers for Medicare and Medicaid Services (CMS). Zone Program Integrity Contractors (ZPICs) have subjected physician practices to Medicare prepayment reviews, postpayment audits, suspension and / or revocation
RAC-Initiated Medicare Prepayment Reviews Will Soon Begin. Read More »
(January 25, 2012): Historically, home health agencies, physicians, clinics and other health care providers have associated the term “whistleblower” with the filing of a FalSe Claims Act case by an insider, former employee or other individual alleging to have direct knowledge of fraudulent billing conduct by a provider. As health care providers will soon find,
Are HIPAA Whistleblower Provisions Around the Corner? Read More »
(January 20, 2012): The Department of Health and Human Services (HHS) has long used reports and complaints from affected patients to further conduct Medicare audits of possible Medicare fraud, waste and abuse. Last June, it was reported that HHS was planning on implementing a “Mystery Shopper” program, with a Federal contractor posing as a potential
The Senior Medicare Patrol is Here! Read More »
You must be logged in to post a comment.