Search Results for: Special Investigations Unit

Agencies Around the Country are Facing Expanded Administrative Medicare Hospice Audits and Investigations - Liles Parker

Agencies Around the Country are Facing Expanded Administrative Medicare Hospice Audits and Investigations

Home Health & Hospice /

(November 5, 2024): It’s been a frustrating year for many Medicare hospice providers around the country. Throughout 2024, hospice agencies have been under the focused scrutiny of both program integrity[1] and administrative claims processing[2] contractors working for the Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS). Unfortunately, the government’s […]

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Ketamine Audits and Investigations are on the Rise - Featured Image

Ketamine Audits and Investigations are on the Rise! Are Your Ketamine Infusion / Injection Practices Compliant with the Law?

Medicare, Medicaid & Private Payor Updates /

(October 10, 2024): Ketamine has been in the news again lately. . . for all the wrong reasons. In August 2024, Federal prosecutors out of the Central District of California announced the indictment of five individuals, including two physicians, who allegedly played a role in the fatal ketamine overdose of Matthew Perry in October 2023.

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Amniotic Membrane - Featured Image - Liles Parker

Navigating Amniotic Tissue / Amniotic Membrane / Skin Substitute Audits and Investigations

Medicare, Medicaid & Private Payor Updates, Other /

(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

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Texas HHSC-OIG is Ramping-Up its Investigations of Medicaid Pediatric Telemedicine Claims

Medicare, Medicaid & Private Payor Updates /

(June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million[1] Texans (approximately 18.9% of the current population[2]) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40

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Medicare Advantage SIU Audits and Investigations are More Prevalent Than Ever

Medicare, Medicaid & Private Payor Updates, Other /

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

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Amniotic Fluid / Amniotic Membrane Tissue Audits, Investigations and Prosecutions are Continuing to Climb in 2022

Medicare, Medicaid & Private Payor Updates /

(August 4, 2022): Over the past year, we have seen a significant increase in the number of Medicare administrative audits, False Claims Act investigations and criminal prosecutions by the Department of Justice (DOJ), related to the billing of allogeneic (harvested from someone else) stem cell products. Medicare and Medicaid claims stemming from amniotic liquid and

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VA Acupuncture Audits of Non-VA, Community Providers are Increasing

Home Health & Hospice, Other /

(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

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United Concordia Dental and its SIU are Actively Auditing Dentists Around the Country.

Dental Audits & Compliance /

(September 15, 2020): There are approximately 1.4 million active duty service members in our country. These active duty service members have approximately 1.9 million dependents. Our military also consists of almost a million reserve and national guard participants. Depending on an individual’s status, these active duty service members, their dependents, and reservists are likely eligible

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Recent Developments in Personal Care & Community-Based Services in Medicaid and Medicare

Home Health & Hospice /

(March 23, 2020): Until recently, personal care services, such as home health aides, were not covered under the Medicare program unless they were part of a skilled service where the beneficiary was homebound.  However, beginning with calendar year 2019, the Medicare program has expanded the ability of plans that participate in the Medicare Advantage program

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