Search Results for: Special Investigations Unit

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

(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 …

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

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

(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 …

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

Overview of Dental Claims Audits and Investigations by Medicaid and Private Payors in 2019

(March 4, 2020):  Many dentists and dental practices around the country are glad that 2019 is behind us.  Last year was a banner year for law enforcement investigators and administrative auditors of dental claims.  Federal and State prosecutors around the country actively pursued both civil and criminal cases against individual dentists for a variety of …

Overview of Dental Claims Audits and Investigations by Medicaid and Private Payors in 2019 Read More »

Investigations of Medicaid Dental Fraud in Texas

(July 1, 2014): Law enforcement authorities are actively investigating and prosecuting health care providers for crimes based upon allegations of Medicaid dental fraud in Texas. When looking for fake billing to the Medicaid program, investigators have historically targeted hospitals and doctors, but increasingly dentists have come under watch. In Texas, new measures have been adopted to …

Investigations of Medicaid Dental Fraud in Texas Read More »

SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment.  Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant?

(October 16, 2019):  A Federal District Court Judge recently sentenced a Murfreesboro, TN dentist to prison and ordered that he pay restitution to TennCare (Tennessee’s Medicaid program).  Regrettably, the types of improper billing practices cited by the government in the criminal Information filed against the defendant dentist aren’t that uncommon.  This recent prosecution serves as …

SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment.  Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant? Read More »

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements?

(January 3, 2019):  Slowly but surely, the percentage of adults and children with dental insurance coverage benefits has gradually climbed.  These increases have been driven, at least in part, by several factors.  First, despite the fact that traditional Medicare does not cover routine dental services, a number of Medicare Advantage plans are now offering coverage …

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements? Read More »

robert-founder-lilesparker

Robert W. Liles, J.D., M.B.A., M.S.

Managing Member Office: (202) 298-8750 Facsimile: (202) 337-5804 rliles@lilesparker.com Schedule a Free Consultation with Robert W. Liles Robert W. Liles has worked in regulatory compliance as a Federal prosecutor and as defense counsel, for more than 25 years. This has provided a unique perspective on the challenges faced by clients in highly regulated industries such …

Robert W. Liles, J.D., M.B.A., M.S. Read More »

Chiropractor Owned Multidisciplinary Practices are at a Higher Risk of Audit

(January 13, 2021):  Over the last few years, we have noted a significant increase in the number of audits initiated against Chiropractor owned multidisciplinary practices.  Typically, these integrated medical practices and clinics employ at least one Chiropractor (typically in an ownership or managerial capacity), along with multiple Doctors of Medicine (MDs), Doctors of Osteopathy (DOs). …

Chiropractor Owned Multidisciplinary Practices are at a Higher Risk of Audit Read More »

pierce corporate veil-lilesparker

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

(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 »