overpayment

pierce corporate veil-lilesparker

Pierce the Corporate Veil — Are You Personally Liable for a UPIC Overpayment?

Regulatory Issues | Privacy | Other /

(Updated January 9, 2021): Owners of healthcare companies often wonder whether the government can pierce the corporate veil and try to hold the owners personally liable for overpayment claims when facing a program integrity audit by a Unified Program Integrity Contractor (UPIC). [1] This rarely happens, but assuming that a provider does not prevail in […]

Pierce the Corporate Veil — Are You Personally Liable for a UPIC Overpayment? Read More »

CMS Expands ALJ Appeal Claim Settlement Process to Include Part A Providers

Medicare, Medicaid & Private Payor Updates /

(April 4, 2016) In an effort to reduce the enormous backlog of pending Administrative Law Judge (ALJ) appeals, the Centers for Medicare and Medicaid Services (CMS) recently announced that it has expanded the pilot Settlement Conference Facilitation (SCF) process to include Part A claims. This process, which was previously only available to providers with pending

CMS Expands ALJ Appeal Claim Settlement Process to Include Part A Providers Read More »

Individual Liability for Medicare Overpayment Claims

Medicare, Medicaid & Private Payor Updates /

(February 24, 2015): Medicare recently finalized regulations allowing enrollment as a Medicare provider to be denied if any owner or control person of the enrolling provider is affiliated with another provider which owes money to Medicare. These regulations are based on sections of the 2010 Affordable Care Act (ACA). They provide CMS an indirect means

Individual Liability for Medicare Overpayment Claims Read More »

Dental Fraud Investigation Results in $5.05 Million Recovery

Dental Audits & Compliance /

(November 10, 2014): Has your dental practice been the subject of a dental fraud investigation? Medicaid dental audits are becoming increasingly prevalent throughout the United States. An Oklahoma-based dental practice has recently agreed to pay $5.05 million in civil claims stemming from allegations that the practice committed Medicaid dental fraud, submitting false claims to Medicaid

Dental Fraud Investigation Results in $5.05 Million Recovery Read More »