"Nationwide Healthcare Lawyers"
Today, it is more essential than ever that health care providers take great care when assessing a patient’s clinical needs and determining which care and treatment is medically necessary. Once this decision is made, it is imperative that health care providers submitting claims to governmental and private payors fully understand their obligations under the law […]
Eight Elements of a Payable Medical Claim Read More »
(Updated January 9, 2021): Each year, our attorneys and paralegals review and assess literally thousands of Medicare claims which have been audited (and denied) by Unified Program Integrity Contractors (UPICs) and other contractors working for the Centers for Medicare and Medicaid Services (CMS). Are you preparing for a UPIC audit? If your Medicare or Medicaid
Preparing for a UPIC Audit? Examine These Eight Claim Elements 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
In July 1965, President Lyndon Johnson signed legislation enacting Medicare and Medicaid into law [1]. In doing so, he ushered in a new era of Federal health benefits, the size and corresponding expense of which never could have been anticipated at the time of passage. Over the last fifty years, the various laws, regulations and
Regulatory Compliance Issues and Guidance Read More »
(September 29, 2014) In the last article, we discussed the importance of conducting HIPAA security risk assessments, as part of your obligations under the HIPAA Security rules. The importance of promptly conducting a risk analysis if it has not yet done cannot be overestimated, as the HHS Office for Civil Rights (OCR) has now announced
HIPAA Security Risk Assessments are Essential Read More »
(October 3, 2022): Aquatic therapy is a common method of rehabilitation and maintenance for several types of injuries and conditions, and the practice is widely accepted by Medicare, Medicaid and many private payors. Historically, both payors and law enforcement have routinely audited aquatic therapy claims. The Centers for Medicare and Medicaid Services (CMS) initially suspended
Enforcement Efforts Targeting Aquatic Therapy Providers and CPT Code 97113 Claims Read More »
The most severe administrative sanctions available under the Social Security Act stems from the authority of the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) [1] to “exclude” individuals and entities from participating in Federal health care programs. Indeed, an OIG Exclusion [2] imposed by the OIG is
OIG Exclusion Actions — Mandatory and Permissive Exclusion Authorities Read More »
Out of the thousands of Federal criminal laws currently in effect, there are handful of rarely cited offenses that have been “resurrected” so to speak, by the government in health care fraud and other white-collar prosecutions. One of these criminal laws is the “Misprision of a Felony” statute. This law has a long and storied
Misprision of a Felony – 18 U.S.C. § 4 Read More »
(March 27, 2019): We live in trying times. As the coronavirus disease (COVID-19) has spread both globally and throughout the United States, the government has taken a number of steps to address the current pandemic. On March 13, 2020, President Donald Trump officially declared that the COVID-19 outbreak constitutes a national emergency.[1] Within 72 hours
(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
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