"Nationwide Healthcare Lawyers"
(August 27, 2010): Additional cities will be getting Medicare fraud HEAT teams. Yesterday, Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” In addition to these agency heads, participants learned of current and […]
Additional Cities will have HEAT Teams in 2011 Read More »
(August 25, 2010): CGI Technologies and Solutions, Inc., (CGI), has announced it will immediately begin reviews on 18 newly approved projects that involve the medical necessity of selected inpatient DRG payments. A complete list of the “issues” currently being examined by CGI can be found on its website. Recovery Audit Contractors (RACs), such as CGI,
(August 17, 2010): Last week, the Centers for Medicare and Medicaid Services (CMS) issued MLM Matters SE1022, titled “Medical Record Retention and Media Formats for Medical Records” directed toward physicians, non-physician practitioners, suppliers, and other health care providers submitting claims to Medicare contractors for services provided to Medicare beneficiaries. As CMS acknowledged, medical record retention
CMS Issues Medical Record Retention Reminder: MLM Matters SE1022 Read More »
(July 11, 2024): Last week, the Department of Justice (DOJ) announced that it has criminally charged 193 defendants with violations of various health care fraud statutes. The government estimates that the fraudulent schemes employed by the defendants resulted in losses of $1.6 billion to Federal, State, and private payor health care programs. These cases are
(July 16, 2010): If there were ever any doubts that ZPICs are going to make their presence known in South Texas now that they have replaced PSCs,those doubts can be put to rest. Health Integrity LLC, the Zone 4 contractor, is proving to be an active and aggressive auditor of physician practices, physical therapy services,
South Texas Medicare Providers are Under the ZPIC Microscope Read More »
(July 15, 2010): When handling Medicare overpayments, providers must exercise caution. Since the May 2009 passage of the Fraud Enforcement and Recovery Act (FERA) and subsequent enactment of the Affordable Care Act (ACA), we’ve heard a lot about how the government looks at Medicare overpayments and how providers should handle them. Prior to the clarification
(July 12, 2010): Can a ZPIC extrapolate the alleged damages in a case. If the ZPIC’s statistical methodology is properly handled, the extrapolation of alleged damages can be a surefire way of destroying a provider’s practice. We’ve known it for years and yet the government’s passion for statistical sampling only seems to be growing. This
Can a ZPIC Extrapolate the Alleged Damages in a Medicare Claims Audit? Read More »
(July 9, 2010): Does the failure to promptly return a Medicare overpayment really warrant liability under the False Claims Act (FCA)? Congress thinks so. The Patient Protection and Affordable Care Act (also known as the “Affordable Care Act” or “ACA”) creates an obligation under the FCA whereby a Medicare provider who fails to timely report
ACA Reporting and Repayment Mandates are a Real Minefield for Medicare Providers. Read More »
(July 5, 2010): The Federal Trade Commission (FTC) has agreed to once again delay enforcement of its illogical and onerous identity theft Red Flags rule with respect to physicians.The Red Flags rule arose under the Fair and Accurate Credit Transactions Act of 2003 and requires “financial institutions” and “other creditors” to develop written plans to
Identity Theft — Red Flags Rule — Treating Doctors Like Banks Is Delayed Once Again Read More »
(June 28, 2010): On Friday, June 25, 2010, President Obama signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962), commonly referred to as the Doc Fix, which provides yet another band-aid for our broken Medicare physician pay system. The bill replaces the 21% Medicare physician payment
Enactment of Doc Fix Bill Offers Another Temporary Reprieve for Medicare Physicians Read More »