"Nationwide Healthcare Lawyers"
(October 27, 2015): Over the past year, Medicare fraud enforcement efforts throughout Texas have resulted in multiple convictions. These increased enforcement efforts should serve as a reminder to all Texas health care providers and suppliers that full compliance with applicable statutory and regulatory requirements is not an option — it is a necessity. I. Medicare […]
Medicare Fraud Enforcement Efforts Are Rising in Texas Read More »
(October 26, 2015): Last month, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) released a study entitled “Questionable Billing for Medicare Ophthalmology Services.” As the study findings reflect, the OIG concluded that for the year 2012, approximately $171 million of the Medicare payments made that year for ophthalmology services were
Medicare Ophthalmology Audits: Is Your Practice Ready? Read More »
(October 20, 2015): As required by the Small Business Jobs Act of 2010, the Department of Health and Human Services (HHS) is required to conduct a review of payments for Medicare fee-for-service claims by using “predictive analytics technologies” every three years. Predictive analytics technologies employ a variety of predictive models and statistical analysts for detection
ZPIC Use of the Medicare Fraud Prevention System Read More »
(October 15, 2015): In an effort to stem the ever-increasing tide of claim appeals, CMS recently issued new guidance (MLN Matters SE1521) to its Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the conduct of requests for redetermination and reconsideration, respectively. Effective 08/01/15, MACs and QICs may no longer review claims denied during
CMS Issues New Instructions to its Contractors Regarding the Scope of Claim Appeals Read More »
(October 12, 2015): The Federal HCQIA peer review statute affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. These due process rights are expressed as a right to a hearing, and are
Structural Denial of Due Process in HCQIA Peer Review Proceedings Read More »
(September 17, 2015): Despite the fact that Medicare and Medicaid requires that participating providers implement a compliance plan, most small providers have yet to complete the necessary steps to accomplish this requirement. “My office manager went to a continuing education program, and she’s come back telling me we need a compliance program. I don’t know about
How to Implement a Compliance Plan in Your Practice Read More »
(August 15, 2015): The Centers for Medicare and Medicaid Services (CMS) has awarded the contract for Zone Program Integrity Contractor (ZPIC) services for Zone 6 to SafeGuard Services, LLC. Zone 6 encompasses Maryland, Delaware, Washington, D.C., Pennsylvania, New Jersey, New York, Connecticut, Massachusetts, Rhode Island, Vermont, New Hampshire, and Maine. SafeGuard is the current program
CMS Awards Zone 6 ZPIC Contract to SafeGuard Services Read More »
This article is reprinted with permission from the June 2015 edition of the American Health Lawyer Association Journal of Health and Life Sciences Law, volume 8, number 3 at page 3. The Journal has an online order link here for anyone who wishes to subscribe. (July 8, 2015): On March 31, 2015, the United States
Challenging Medicaid Underpayments: Impact of the Armstrong Case Read More »
(June 1, 2015): As set out in the 2015 mid-year OIG Work Plan, the agency has once again announced its intentions to report on numerous types of potential fraud, waste, and abuse in HHS programs, as well as on the economy, efficiency, and effectiveness of the programs. The OIG plans to produce 193 reports in
The 2015 Mid-Year OIG Work Plan Has Been Released Read More »
(May 5, 2015): As the health care providers and suppliers we represent can easily attest, there are serious problems plaguing the current Medicare appeals process. Rubber-stamp denials by contractors[1] at lower levels of appeal, the failure of Medicare contractors to apply the correct coverage rules and requirements when assessing a claim, and lengthy delays in
The Medicare Appeals Process is Broken Read More »
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