"Nationwide Healthcare Lawyers"
(October 10, 2024): Ketamine has been in the news again lately. . . for all the wrong reasons. In August 2024, Federal prosecutors out of the Central District of California announced the indictment of five individuals, including two physicians, who allegedly played a role in the fatal ketamine overdose of Matthew Perry in October 2023. […]
(August 14, 2024): For almost a century, health care providers have used amniotic tissues / amniotic membranes in the care and treatment of wounds.[1] In recent years, health care providers have greatly expanded the scope of therapeutic applications employing amniotic tissues / amniotic membranes in wound care procedures. These developments have led to increased scrutiny
(June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million[1] Texans (approximately 18.9% of the current population[2]) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40
Author: Ashley Morgan, Annabella Denzel (April 5, 2023): In the sphere of healthcare compliance, providers must manage audits coming from every possible authority whether it be from public agencies, a private payor, or other third-party authorities. CMS has announced that the FY 2022 fee-for-service improper payment rate was 7.46%.[1] While this is a slight increase
Medicare Advantage SIU Audits and Investigations are More Prevalent Than Ever Read More »
(August 4, 2022): Over the past year, we have seen a significant increase in the number of Medicare administrative audits, False Claims Act investigations and criminal prosecutions by the Department of Justice (DOJ), related to the billing of allogeneic (harvested from someone else) stem cell products. Medicare and Medicaid claims stemming from amniotic liquid and
(May 20, 2022): Acupuncture audits and investigations by federal, state and private payors have greatly expanded in recent years. One of the most active players conducting acupuncture audits today is the U.S. Department of Veterans Affairs. (VA). It is worth noting that long before traditional Medicare even considered covering acupuncture services,[1] the VA made these
VA Acupuncture Audits of Non-VA, Community Providers are Increasing Read More »
Last month, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare fee-for-service improper payment rate had declined from 11% in Fiscal Year (FY) 2016 to approximately 6.27% in FY 2020. [1] Despite the fact that real progress in reducing the amount of improper Medicare payments has been made, health care fraud, waste
Special Investigative Unit (SIU) Audits Read More »
(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 »
(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 »
(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
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