Medicare Termination / Medicare Revocation Cases: Tips for Avoiding & Steps for Appealing.
(September 16, 2014): Consider the following scenario. You own a durable medical equipment (DME) company that you run out of a leased location in a local office building. Your customers are a mix of privately insured and Medicare/Medicaid beneficiaries. You've been in business for about 10 years, but money is tight and you need to reduce expenses. You decide to move your business to your home for the time being. You make all the arrangements to move, and prepare a CMS-Form 855S informing the National Supplier Clearinghouse (NSC) that you are relocating in 10 days. No one helps you fill ...
CMS Offers Labor Day “Sale” on Audit Appeals
The Centers for Medicare & Medicaid Services (CMS) decided to get involved in the nationwide Labor Day sale phenomenon. As part of its ongoing efforts to alleviate the backlog in Medicare claim appeals, CMS has quietly offered to pay any hospital 68% of their appealed claims. The catch? The hospital must withdraw its appeal. This latest move is part of an ongoing fight between CMS, its contractors, and hospitals over reimbursement amounts for short-term inpatient stays. I. Increased RAC Audits Lead to Increase in Appeals As Medicare providers are well aware, CMS hired Recovery Audit Contractors, or “RACs”, to identify and recover ...
Oncology Fraud: Michigan Oncologist Indicted for Prescribing Medically Unnecessary Chemotherapy and Other Treatment Regimens
(August 29, 2014) The American Cancer Society has estimated that 43.92% of all males and 38.00% of all females in the United States will develop cancer at some point during their lifetime. While a number of clinical advances have been made over the last 25 years, chemotherapy remains one of the predominant tools used to fight cancer in many of its various forms. Depending on the type of cancer at issue, chemotherapy can be used as a primary or as an adjuvant therapy. While a number of drugs have been developed to address several of the adverse side effects normally associated ...
Peer Review Actions: How HCQIA Due Process Fails the Accused Physician
(August 31, 2014): The Healthcare Quality Improvement Act of 1986 (“HCQIA”, generally pronounced “Hick Kwah”), affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. I. Overview: Under HCQIA, a physician’s due process rights are typically expressed as a right to a hearing, and are generally outlined in a hospital staff’s bylaws. Most hospitals in the United States have structured the process so that a physician’s hearing and other due process rights arise only after a decision on the ...
Health Law ArticlesMedicare Termination / Medicare Revocation Cases: Tips for Avoiding & Steps for Appealing. CMS Offers Labor Day “Sale” on Audit Appeals Oncology Fraud: Michigan Oncologist Indicted for Prescribing Medically Unnecessary Chemotherapy and Other Treatment Regimens Peer Review Actions: How HCQIA Due Process Fails the Accused Physician CMS Clarifies HHA Definition of “Confined to Home” Read More Posts From This Category
Dental Law ArticlesMedicaid Dental Fraud: Is the State of Texas Partly to Blame? Investigations of Medicaid Dental Fraud in Texas Medicaid Dental Fraud: New Hampshire Dentist Indicted on Nearly 200 Counts of Medicaid Fraud. Medicaid Dental Fraud: Dentist Alleged to Have “Systematically Bilked” the State in Dental Fraud Scheme. Medicare Dental Services: Take Care to Ensure that Your Hospital Outpatient Dental Services Meet Medicare’s VERY Limited Coverage Requirements Before Billing the Program. Read More Posts From This Category
Municipal Law ArticlesCMS Announces RAC Audit “Pause” and Additional RAC Program Reforms
The Centers for Medicare & Medicaid Services (CMS) recently announced that... [Read more of this review]Peddling and Soliciting, Municipal Regulations These Issues Can be Complex. Is Your City Clear on these Points?
(January 8, 2013): As a general rule cities can regulate hawking, canvassing,... [Read more of this review]City Contracts and Arbitration
It is recommended that cities do not agree to arbitration, either voluntarily or... [Read more of this review]Read More Posts From This Category
Business & Transaction ArticlesThe Dangers of Keeping Medical Records in the “Cloud”
(July 3, 2014): The growing trend of storing all kinds of data in the cloud comes... [Read more of this review]Liles Parker Attorney has Article Titled “Individual Liability in Medicare Overpayment Cases” Published in Law Journal.
Will the government seek to “pierce the corporate veil”? (October 16,... [Read more of this review]A Recent False Claims Act Case Being Brought Against an Individual Physician has Resulted in a Record Recovery for the Government.
(February 12, 2013): The civil False Claims Act is the primary civil enforcement... [Read more of this review]Read More Posts From This Category