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Navigating the Surge in SIU Audits of Lactation Consultant Services

Medicare, Medicaid & Private Payor Updates / Annabella Denzel

(October 2, 2026): As health care providers and suppliers across the country will readily confirm, government and private payor examiners and investigators are actively auditing a wide range of services and supplies billed to insurance. This scrutiny has included audits by private payor insurance company Special Investigative Units (SIUs) of services billed by allied health

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The Criminalization of Pain: The Risks of Prescribing Controlled Substances

Medicare, Medicaid & Private Payor Updates / Robert Liles

(August 3, 2026): Pain has become a place where medicine, law, and patient needs collide. Chronic pain is not a marginal public-health issue. In its most recent survey, the Centers for Disease Control and Prevention (CDC) estimated that 60 million adults, nearly 1 in 4, in the United States suffer from chronic pain. More than

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Expansions of the Medicare Revocation Rules are on the Horizon

Medicare, Medicaid & Private Payor Updates, Other / Michael Tobin

(July 23, 2026): On July 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published a Proposed Rule that was extraordinarily broad in its scope, covering topics ranging from the Home Health Prospective Payment System to the Medicare Enrollment Rules.[1] This article focuses on CMS’s proposed expansion of Medicare’s existing enrollment enforcement authorities, particularly

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CMS, OIG and DOJ are Auditing Office Based Peripheral Vascular Procedure - Featured Image - Liles Parker

CMS, OIG, and DOJ are Auditing Office-Based Peripheral Vascular Procedures

Medicare, Medicaid & Private Payor Updates / Meaghan DeBenedetto

(July 8, 2026): Since 2023, ProPublica[1] has conducted a broad investigation into the extraordinarily high number of peripheral vascular procedures performed in office-based laboratories (OBLs) rather than hospital outpatient departments around the country. Over the last three years, the organization has published at least fourteen articles examining the medical necessity and over-utilization of these procedures.[2]

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House Seeks to Defund the WISeR Program – Providers Won’t See Relief Any Time Soon

Medicare, Medicaid & Private Payor Updates / Ashley Morgan

(June 23, 2026): This week, the U.S. House of Representatives’ Appropriations Committee approved draft Fiscal Year (FY) 2027 appropriations language covering the Department of Health and Human Services (HHS). If ultimately enacted, this appropriations language will bar the use of federal funds to implement the Centers for Medicare & Medicaid Services’ (CMS) “Wasteful and Inappropriate

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Staying Ahead of the Surge in Medicare Revocation Actions

Medicare, Medicaid & Private Payor Updates / Ashley Morgan

(April 13, 2026): Physicians, home health agencies, and hospices constantly strive to ensure the well-being of their patients. Unfortunately, over the past few years, scores of providers have found themselves at odds with the Centers for Medicare & Medicaid Services (CMS) and its contractors. If you think “It Can’t Happen to Me,” consider this –

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Transcranial Doppler Claims are Being Audited - Featuered Image - Liles Parker

Transcranial Doppler Claims are Being Audited. Are You Ready?

Medicare, Medicaid & Private Payor Updates / Matthew Catoe

(February 2, 2026): Neurologists, radiologists, and vascular surgeons around the country who perform Transcranial Doppler Ultrasound procedures are currently under the government’s regulatory microscope. Therefore, it is more important than ever that you review your business practices to confirm your transcranial doppler procedures fully meet applicable medical necessity, documentation, coding, and billing requirements. As discussed

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Responding to Medicare Audits of PCR Testing for UTIs in 2026

Medicare, Medicaid & Private Payor Updates / Christin Thompson

(December 18, 2025): Laboratory Polymerase Chain Reaction (PCR) testing for urinary tract infections (UTIs) offers rapid, sensitive pathogen detection but often presents complex coding and billing challenges for Medicare providers and laboratories. Medicare contractors are increasingly denying UTI test claims due to issues with medical necessity, documentation, and improper coding/billing practices. Robust compliance and up-to-date

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Wound care aukdit and skin substitute audit 2026 - Featured Image - Liles Parker

Responding to Wound Care Audits and Skin Substitute Audits in 2026

Medicare, Medicaid & Private Payor Updates, Other / Ashley Morgan

CMS UPDATE – DECEMBER 24, 2025 “Effective immediately, CMS’ A/B Medicare Administrative Contractors (MACs) are withdrawing the Local Coverage Determinations (LCDs) for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers that were scheduled to become effective on January 1, 2026.” ORIGINAL ARTICLE (December 11, 2025): In 1789,

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Prior Authorization Audits for Certain ASC Services in 2026 - Featured Image - Liles Parker

Prior Authorization Demonstration Audits for Certain ASC Services Start in January 2026

Medicare, Medicaid & Private Payor Updates / Christin Thompson

(December 09, 2025): The Government Accountability Office (GAO) has long expressed concerns regarding the fraud, waste and abuse risks inherent in the Medicare program. In fact, GAO first designated Medicare as a “High Risk” program due to its size, complexity and susceptibility to improper payments.[1] Throughout 2025, Medicare providers and suppliers were subjected to significant

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Medicare, Medicaid & Private Payor Updates