Search Results for: private overpayment

Personal Care Services Are Under the Government’s Microscope

Home Health & Hospice /

(January 22, 2018): The Department of Health and Human Services, Office of Inspector General (HHS-OIG) has conducted numerous audits, evaluations, and investigations involving the provision of “personal care services” to Medicaid beneficiaries.  In fact, from 2006 to 2012, HHS-OIG produced more than 20 audit and evaluation reports analyzing various program integrity risks presented when providing […]

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Liles Park – Nationwide Health Care Lawyers

We Defend Healthcare Providers Nationwide in Audits & Investigations. Liles Parker PLLC is a health care regulatory firm representing health care providers and suppliers around the country in complex business transactions, administrative, civil and criminal litigation. Founded by a former Federal prosecutor and the former General Counsel of a Fortune 500 company, Liles Parker has

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UPIC / ZPIC / Health Integrity Opioid Audits and Audits of Other High Risk Drugs.

Medicare, Medicaid & Private Payor Updates /

(June 23, 2017): Opioid audits of the prescribing practices of pain management physicians are on the rise. As the Department of Health and Human Services (HHS), Office of Inspector General (OIG), noted in its report “High Part D Spending o Opioids and Substantial Growth in Compounded Drugs Raise Concerns,” 30% of Medicare beneficiaries have at

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UPIC Claims Audits of Medicare Services are Underway! Are You Ready?

Medicare, Medicaid & Private Payor Updates /

(Updated March 20, 2020): Historically, the Centers for Medicare and Medicaid Services (CMS) has relied on a network of private contractors to handle the program integrity functions for both the Medicare and Medicaid programs. Over the years, these private contractors have taken on increasingly significant roles in the detection and audit of instances of fraud,

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Medicare Chiropractic Audits are Increasing!

Medicare, Medicaid & Private Payor Updates /

(June 5, 2017): Despite the fact that only three treatment services are covered by Medicare, the number of Medicare chiropractic audits conducted by the Department of Health Human Services (HHS), Office of Inspector General (OIG), has remained high over the last decade and is anticipated to grow throughout 2017 and 2018. As you are aware,

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Delta Dental Audits are Ongoing Around the Country. Are You Prepared?

Dental Audits & Compliance /

(May 15, 2017): Over the last decade, both state and federal law enforcement agencies have aggressively investigated and prosecuted instances of Medicaid dental fraud. In recent years, these efforts have been widely implemented (and expanded) by private payor Special Investigative Units (SIUs). One dental benefits program in particular has been especially active in this regard

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ZPIC Audit Responsibilities Have Been Transferred to UPICs Around the Country

(Updated January 4, 2021): In April 2014, the Centers for Medicare and Medicaid Services (CMS) issued an an Umbrella Statement of Work for the the awarding of program integrity contracts by new organizations known as “Unified Program Integrity Contractors” (UPICs). UPICs took over the responsibilities of Zone Program Integrity Contractors (ZPICs) and Medicaid Integrity Contractors

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Dental Practice Audits are on the Rise — Protect your Interests!

Dental Audits & Compliance /

(October 11, 2016): More than 45 million children receive government-funded dental care served under Medicaid and CHIP programs. This equates to approximately 1 out every 3 children in the country. The dental care provided includes screening services and other preventive, diagnostic, and treatment services that are medically necessary and properly documented. Under the mandatory Early

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