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Health Integrity Audits of Texas and Oklahoma Home Health Agencies are on the Rise.

Home Health & Hospice /

(August 14, 2011): Home health agencies in Texas and Oklahoma remain under considerable scrutiny by Medicare contractors tasked with identifying fraud and abuse perpetrated against the Medicare Trust Fund. As discussed below, these Medicare contractors have a number of tools at their disposal, many of which can effectively place a home health agency in financial […]

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Ten Recommendations to Improve Medicare Compliance and Prepare for a ZPIC Audit

Medicare, Medicaid & Private Payor Updates /

(July 24, 2011): Has your Texas physician practice, home health agency, hospice, DME company or PT / OT / ST clinic been audited by a Zone Program Integrity Program (ZPIC)? If not, it may only be a matter of time. Despite your best efforts to follow Medicare’s directives, your organization may still be identified as

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NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5.

Medicare, Medicaid & Private Payor Updates /

(April 10, 2011): Last week, it was announced that NCI, Inc., one of the nation’s most successful information technology companies had acquired the outstanding capital stock of AdvanceMed Corporation (AdvanceMed), an affiliate of CSC. While the acquisition went largely unnoticed by the health care provider community, the transaction may, in fact, be quite significant. With

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CERT Postpayment Audits: An Overview of the Audit Process

Medicare, Medicaid & Private Payor Updates /

(March 12, 2011): Health care providers around the country are finding their practices and clinics subjected to Medicare post-payment audits by Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Comprehensive Error Rate Testing (CERT) Contractors. While all post-payment audits should be taken seriously, there are real differences between both the contractors and the

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CMS Authorizes Medicare Appeals by Fax and Secured Internet

Medicare, Medicaid & Private Payor Updates /

(November 21, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating that this change

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Health Data Insights Begins Medical Necessity Reviews

Medicare, Medicaid & Private Payor Updates /

(August 30, 2010): Health Data Insights (HDI), the Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC) responsible for auditing health care providers in Region D, has announced it will immediately begin reviews on previously approved projects which involve the medical necessity of selected inpatient DRG payments. A complete list of the medical

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Responding to a Search Warrant Executed at Your Health Care Practice or Clinic

Medicare, Medicaid & Private Payor Updates /

(June 1, 2010): Like most honest health care providers, you may believe that search warrants are only executed by the government in connection with the investigation of nefarious characters and criminals. Unfortunately, that just isn’t the case. The Federal government has increasingly utilized search warrants as a first-strike investigative tool. In fact, the execution of

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Is a ZPIC Tougher than a RAC or PSC When Conducting Medicare Audits?

Medicare, Medicaid & Private Payor Updates /

(March 25, 2010): The Recovery Audit Contractor (RAC) program is an integral part of the Centers for Medicare & Medicaid Services’ (CMS’) “benefit integrity” efforts which seek to identify and recoup alleged overpayments paid to Medicare providers. Similarly, Program SafeGuard Contractors (PSCs) have been actively auditing Medicare providers and suppliers around the country. While the

Is a ZPIC Tougher than a RAC or PSC When Conducting Medicare Audits? Read More »

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Jennifer Papapanagiotou, J.D., M.S.

Jennifer Papapanagiotou focuses her practice on transactional, corporate and regulatory matters for health care providers, including but not limited to: physicians and physician organizations, hospitals, laboratories, home health agencies, hospice providers, mental health professionals, and durable medical equipment companies. She also works extensively with health care management and billing companies. Her work focuses on the

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David P. Parker

David Parker practices in the business transaction and healthcare areas. His business practice includes overseeing all legal aspects of private debt and equity financings and the purchase and sale of businesses. He represents buyers and sellers in the purchase or sale of business operations and entities. He has experience in originating, syndicating, closing, servicing, and

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