"Nationwide Healthcare Lawyers"
(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 »
(December 19, 2011): As you know, RACs play an important role in the identification of Part A and Part B overpayments. Since the inception of the RAC Demonstration Project in 2005, RACs have successfully identified a number of improper claims, denying payment for reasons ranging from mere technical errors to broad concerns about medical necessity.
Is a RAC Prepayment Review of Your Medicare Claims on the Horizon? Read More »
(November 23, 2011): The “Comprehensive Error Rate Testing” (CERT) program was implemented as a mechanism for the Centers for Medicare and Medicaid Services (CMS) to assess whether their Medicare Administrative Contractors (MACs) are properly paying claims. In other words, is a particular MAC failing to identify and deny improper claims? Alternatively, is the MAC denying
A CERT Audit Is Serious – Don’t Take These Medicare Reviews Lightly Read More »
(November 16, 2011): Many providers believe that their practice is a normal one – average billings, average patient load, costs of care which are consistent with industry standards – and that they need not be concerned with undergoing a Medicare post payment audit for being a “statistical outlier.” As you may know, Medicare and Medicaid
Data Mining is Being Used for ZPICs Targeting Purposes Read More »
(November 15, 2011): Last year, the Centers for Medicare and Medicaid Services (CMS) launched their Physician Compare website. CMS’s Physician Compare website allows beneficiaries to research their health care providers. The Affordable Care Act (commonly referred to as “Health Care Reform”) mandated that CMS launch such a website and that it implement physician performance metrics
CMS’s New Physician Compare Website to Report on Provider Performance Read More »
(November 15, 2011): Understandably, health care providers have grown weary of government audits, malpractice issues, peer reviews and private payor assessments. In an effort to reduce their potential liability, many providers are now regularly utilizing Gap Analyses / Mock Audits to test their preparedness for audit. In doing so, they have been able to identify
Conducting a Gap Analysis / Mock Audit: An Essential Compliance Tool for Your Practice Read More »
(October 25, 2011): As set out under Maryland law, “All students in Maryland’s public schools, without exception and regardless of race, ethnicity, region, religion, gender, sexual orientation, language, socioeconomic status, age, or disability, have the right to educational environments that are safe, appropriate for academic achievement, and free from any form of harassment.” I. Maryland
Maryland Bullying, Cyber Bullying and Hazing Laws Read More »
(July 24, 2011): Has your Texas physician practice, home health agency, hospice, DME company or PT / OT / ST clinic been audited by a Zone Program Integrity Program (ZPIC)? If not, it may only be a matter of time. Despite your best efforts to follow Medicare’s directives, your organization may still be identified as
Ten Recommendations to Improve Medicare Compliance and Prepare for a ZPIC Audit Read More »
(July 16, 2011): As Zone Program Integrity Contractor (ZPIC) audits of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) companies continue to climb, the Department of Health and Human Services, Office of Inspector General (HHS-OIG), has now reported that more than one-half of the recent power wheelchair claims by Durable Medical Equipment (DME) suppliers were