"Nationwide Healthcare Lawyers"
(August 14, 2024): For almost a century, health care providers have used amniotic tissues / amniotic membranes in the care and treatment of wounds.[1] In recent years, health care providers have greatly expanded the scope of therapeutic applications employing amniotic tissues / amniotic membranes in wound care procedures. These developments have led to increased scrutiny […]
Author: Ashley Morgan, Annabella Denzel (April 5, 2023): In the sphere of healthcare compliance, providers must manage audits coming from every possible authority whether it be from public agencies, a private payor, or other third-party authorities. CMS has announced that the FY 2022 fee-for-service improper payment rate was 7.46%.[1] While this is a slight increase
Medicare Advantage SIU Audits and Investigations are More Prevalent Than Ever Read More »
(January 26, 2023): Since the inception of the pilot program in 2015, the Targeted Probe and Educate Audit (TPE audit) program has effectively been a double-edged sword for most providers. On the positive side, it has served as an educational tool that providers can use to better ensure that their medical necessity, documentation, coding and
TPE Audits: The Process & Expected Targets in 2023 Read More »
(October 12, 2022): The False Claims Act is the primary civil enforcement tool utilized by our government today. In Fiscal Year (FY) 2021, the U.S. Department of Justice (DOJ) won or negotiated over $5.6 billion in False Claims Act (FCA)[1] settlements and judgments. Of that amount, more than $5 billion [2] resulted from matters involving
Civil Investigative Demands (CIDs) & Collateral Enforcement Risks: A Review Read More »
(May 20, 2022): Acupuncture audits and investigations by federal, state and private payors have greatly expanded in recent years. One of the most active players conducting acupuncture audits today is the U.S. Department of Veterans Affairs. (VA). It is worth noting that long before traditional Medicare even considered covering acupuncture services,[1] the VA made these
VA Acupuncture Audits of Non-VA, Community Providers are Increasing Read More »
(May 2, 2022): The Supreme Court last addressed violations of 21 U.S.C. §841 by a medical practitioner in 1975.[1] Since that time, several circuit courts have taken different approaches when construing the scienter requirements to prove a Controlled Substance Act violation, and how a jury may be instructed when deciding a case. Hopefully, clarification of
(October 21, 2021): The False Claims Act [1] remains the primary civil enforcement tool utilized by the U.S. Department of Justice (DOJ). While the results of Fiscal Year (FY) 2021 have not yet been published, settlements and judgements in FY 2020 exceeded $2.2 billion. Of this total, $1.8 billion were related to the health care
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