Search Results for: private overpayment

Private Insurance Overpayment & Patient Credit Balance Repayment Obligations

Most health care providers and suppliers have a solid understanding of their obligation to repay overpayments that may be owed to Medicare, Medicaid and other Federal health benefit plans. [1] Unfortunately, they may not fully understand that overpayments never belong to them, even if the monies are not owed to a government payor. If your …

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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 …

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Individual Liability for Medicare Overpayment Claims

(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 to …

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Individual Liability for Medicare Overpayment Claims

(October 19, 2012): This article addresses the case where an individual or “natural person” owns an interest in a Medicare health care provider which is incorporated[1] under the laws of a state, as a corporation, limited liability company, limited partnership, or  another type of legal person. The individual may be a shareholder, member, limited partner, or …

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What are a Dentist’s Medicaid Overpayment Obligations? Part I

(April 24, 2012): While considerable attention has been paid to the Affordable Care Act (generally referred to as “Health Care Reform”) and its requirement that “identified overpayments” be promptly repaid to the government, it is important to keep in mind that this repayment obligation is not new – it has long been firmly in place.  …

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Providers Should Exercise Caution When Handling Overpayments — More Than Likely, You Can’t Keep It, Even if the Payor Doesn’t Want it Back!

(July 15, 2010): When handling Medicare overpayments, providers must exercise caution.  Since the May 2009 passage of the Fraud Enforcement and Recovery Act (FERA) and subsequent enactment of the Affordable Care Act (ACA), we’ve heard a lot about how the government looks at Medicare overpayments and how providers should handle them.  Prior to the clarification and statutory …

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2020 TAHCH webinar

Wednesday, December 2nd, 2020 1 p.m. EST / Noon CST / 10:00 a.m. PST OIG Work Plan 2021 – Is Your Home Health, Hospice or Personal Care Agency in the Government’s Crosshairs? The Office of Inspector General’s “Work Plan” is its general audit and investigative plan for the upcoming year. The publication of OIG’s Work …

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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 …

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CERT Audits

In 1996, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) first estimate the improper payment error rate of Medicare Fee-For-Service (FFS) claims. [1]  From 1996 through 2002, OIG continued to manage this program. In 2002, the Improper Payments Information Act (IPIA) was enacted.[2] Under the IPIA, Federal agencies, including HHS …

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