Medicare, Medicaid & Private Payor Updates

Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded.  What Steps are You Taking to Reduce Your Level of Risk?

Medicare, Medicaid & Private Payor Updates /

Big Changes to CMS Form 855 are on the Horizon[/caption] (September 18, 2019): On September 10, 2019, the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) published a Final Rule in the Federal Register entitled, “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider […]

Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded.  What Steps are You Taking to Reduce Your Level of Risk? Read More »

Genetic Testing Fraud Prosecutions are on the Rise Around the Country. Are Your Genetic Testing Practices Compliant?

Medicare, Medicaid & Private Payor Updates /

(August 13, 2019): Over the last year, a number of genetic testing fraud investigations and prosecutions have been initiated by Medicare, Medicaid and TRICARE investigators and auditors.  While the nature of the diagnostic services at issue are cutting edge, the wrongful conduct associated with these cases often involves old school fraud schemes that are easily

Genetic Testing Fraud Prosecutions are on the Rise Around the Country. Are Your Genetic Testing Practices Compliant? Read More »

OIG’s Renewed Interest in Orthotic Audits and Investigations: What Your DME Company Needs to Know

Medicare, Medicaid & Private Payor Updates /

(February 8, 2019): A series of recent reports out of the Department of Health and Human Services (HHS), Office of Inspector General (OIG) underscore the Federal government’s renewed concerns with respect to orthotic braces, including underlying medical need for these items. From 1994 to 2000, OIG issued half a dozen reports pertaining to orthotics audits

OIG’s Renewed Interest in Orthotic Audits and Investigations: What Your DME Company Needs to Know Read More »

Audits of Telehealth Services are Increasing. Do Your Telehealth Services Meet Applicable Requirements?

Medicare, Medicaid & Private Payor Updates /

(Updated September 22, 2019): The use of “telehealth” technologies to diagnose and treat patients can be used to address provider shortages, improve patient access to otherwise unavailable specialized services, reduces costs, and provides an effective way to monitor the status of patients from long distances. The many benefits of telehealth have been readily recognized by

Audits of Telehealth Services are Increasing. Do Your Telehealth Services Meet Applicable Requirements? Read More »

EKRA: Laboratories, Treatment Homes and Clinical Treatment Centers Now Face Increased Enforcement and Penalties for Kickback Tainted Claims that are Reimbursed by Private Payors.

Medicare, Medicaid & Private Payor Updates /

(December 3, 2018): On October 24th, 2018, President Trump signed into law the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.” This bi-partisan legislation is intended to address a number of the fraudulent and abusive business practices currently employed by unscrupulous substance abuse treatment providers in this segment

EKRA: Laboratories, Treatment Homes and Clinical Treatment Centers Now Face Increased Enforcement and Penalties for Kickback Tainted Claims that are Reimbursed by Private Payors. Read More »

Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant?

Medicare, Medicaid & Private Payor Updates /

(July 16, 2018): Do you provide Transcranial Magnetic Stimulation care and treatment services? If so, you need to ensure that your medical necessity, documentation, coding and billing practices fully comply with applicable statutory, regulatory and administrative guidelines. In recent weeks, a flurry of prepayment review letters from Medicare Administrative Contractors (MACs) have been sent to

Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant? Read More »

Is Your Urogynecology, OB/GYN or Multidisciplinary Practice Prepared for a Medicare Biofeedback Claims Audit or a Pelvic Floor Therapy Claims Audit?

Medicare, Medicaid & Private Payor Updates /

(July 12, 2018): While no medical specialty has completely avoided the scrutiny of law enforcement and government contractors, for the most part, OB/GYNs and Urogynecologists have managed to stay out of the limelight of auditors and investigators tasked with identifying improper billing practices. Unfortunately, those days appear to be over. Working closely with the staff

Is Your Urogynecology, OB/GYN or Multidisciplinary Practice Prepared for a Medicare Biofeedback Claims Audit or a Pelvic Floor Therapy Claims Audit? Read More »

CMS has Confirmed the Coverage of Personal Care Services by Medicare Advantage Plans Starting 2019

Medicare, Medicaid & Private Payor Updates /

(June 26, 2018): The coverage of personal care services by Medicare has been advocated by advocacy groups for many years. As we reported last April, the Centers for Medicare and Medicaid Services (CMS) announced in its Final Call Letter for bids from plans that participate in the Medicare Advantage program (MA) for 2019. In that

CMS has Confirmed the Coverage of Personal Care Services by Medicare Advantage Plans Starting 2019 Read More »

An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions

Medicare, Medicaid & Private Payor Updates /

(May 20, 2018): It’s been a rough week for at least one Texas rheumatologist. Last Monday, the U.S. Attorney’s Office for the Southern District of Texas announced the indictment of a South Texas rheumatologist for multiple counts of health care fraud and one count of conspiracy to commit money laundering. The magnitude of the alleged

An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions Read More »

Expect an Increase in Audits of Chiropractic Services!

Medicare, Medicaid & Private Payor Updates /

(April 16, 2018): Chiropractors around the country are again finding their services and claims under intensive scrutiny from Medicare contractors and investigators, despite the fact that only three services even qualify for coverage and payment. Several weeks ago, the Department of Health and Human Services (HHS), Office of the Inspector General (OIG) released its latest

Expect an Increase in Audits of Chiropractic Services! Read More »