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In an effort to avoid duplication of program integrity efforts and better integrate Medicare and Medicaid audits and investigations under a single contractor in a specific jurisdiction. CMS has contracted with a number of new private sector organizations to serve as Unified Program Integrity Contractors (UPICs). As set out below, Medicare and Medicaid providers and […]
(July 18, 2014): Over the last decade, Compliance Programs have become an essential part of the way large and mid-sized health care providers conduct business. In recent years, small health care providers have followed suit, and Compliance Program development, review and implementation has become a priority if the provider intends on staying within the four
Health Care Compliance Program Development, Review & Implementation Read More »
(January 3, 2014): A 57-year-old Queen City, New Hampshire dentist has recently been charged with 189 counts of Medicaid dental fraud. As a result, he could face many years in prison. The New Hampshire Medicaid program is a joint federal and state-funded health care program that serves individuals and families in that state who meet
Dentist Indicted on Nearly 200 Counts of New Hampshire Medicaid Dental Fraud Read More »
(December 26, 2013): The Department of Health and Human Services (HHS) has long viewed the adoption of Electronic Health Records (EHRs) as a way to better coordinate care, improve the quality of care, reduce unnecessary paperwork, and eliminate duplicative medical testing. Based, at least in part, on these beliefs, Congress authorized incentive payments to encourage
EHR Cloning Practices Can Lead to Medicare Audits Read More »
(November 8, 2013): Health Integrity serves as the Zone Program Integrity Contractor (ZPIC) for Zone 4. This zone is comprised of Texas, Oklahoma, New Mexico and Colorado. Generally, Health Integrity has been assigned responsibility for handling Medicare Part A, Medicare Part B, and Durable Medical Equipment (DME) claims. Health Integrity has been especially aggressive in
Health Integrity Educational Letter Sent to Home Health Agencies in Texas and Oklahoma Read More »
(August 14, 2013): In today’s reimbursement environment, solo physicians and physician practice groups are witnessing a steady decline in reimbursement rates. Unfortunately, their overhead costs and obligations due to the imposition of Electronic Medical Records, HIPAA Privacy, OSHA and a litany of other regulatory requirements are making more and more difficult to remain profitable each
(February 7, 2013): The Texas Medical Board (Medical Board) was quite busy in 2012. While the number of disciplinary action taken had dropped in some categories, it rose in others. In fact, the overall number of complaints filed with the Medical Board was the 2nd highest in the last decade. The Medical Board’s workload numbers
The Texas Medical Board Remains Busy Due to High Number of Complaints Filed in 2012 Read More »
(June 15, 2012): Evaluation and Management (E/M) coding has been the subject of substantial scrutiny in Medicare post-payment audits and appeals for many years. When a reviewer for the Center for Medicare & Medicaid Services (CMS) audits an E/M claim, the reviewer often appears to utilize the AMA CPT Code Book to assess the proper
The Latest OIG Report on E/M Coding Finds that Coding Practices are Trending Higher Read More »
An Attorney Ismail Laher focuses on simplifying complex civil and regulatory matters for individuals and businesses alike. He also serves in the role of outside General Counsel on an as needed basis. Mr. Laher is a graduate of Harvard Business School and Georgetown Law. He was previously associated with the Jones Day law firm in
Ismail (Ish) Laher 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 »
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