"Nationwide Healthcare Lawyers"
(October 19, 2012): This article addresses the case where an individual or “natural person” owns an interest in a Medicare health care provider which is incorporated[1] under the laws of a state, as a corporation, limited liability company, limited partnership, or another type of legal person. The individual may be a shareholder, member, limited partner, […]
Individual Liability for Medicare Overpayment Claims Read More »
(May 24, 2012): The Centers for Medicare & Medicaid Services (CMS) is rolling out a new survey initiative, known as the “National Site Visit Contractor” program. In updates to the Medicare Program Integrity Manual released on April 6, 2012 and April 13, 2012, CMS has somewhat quietly introduced the National Site Visit Contractor program, noting
National Site Visit Contractor Established Read More »
(February 7, 2012): In recent years, physicians and other health care providers have faced a wide number of administrative actions and sanctions levied by contractors working for the Centers for Medicare and Medicaid Services (CMS). Zone Program Integrity Contractors (ZPICs) have subjected physician practices to Medicare prepayment reviews, postpayment audits, suspension and / or revocation
RAC-Initiated Medicare Prepayment Reviews Will Soon Begin. Read More »
(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
Health Integrity Audits of Texas and Oklahoma Home Health Agencies are on the Rise. Read More »
(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
Ten Recommendations to Improve Medicare Compliance and Prepare for a ZPIC Audit Read More »
(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
NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5. Read More »
(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
CERT Postpayment Audits: An Overview of the Audit Process Read More »
(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
CMS Authorizes Medicare Appeals by Fax and Secured Internet Read More »
(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
Health Data Insights Begins Medical Necessity Reviews Read More »
(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
Responding to a Search Warrant Executed at Your Health Care Practice or Clinic Read More »