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

Dental Audits & Compliance / By

(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

Medicare, Medicaid & Private Payor Updates / By

(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 …

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Individual Liability for Medicare Overpayment Claims

Medicare, Medicaid & Private Payor Updates / By

(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, …

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

Dental Audits & Compliance / By

(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!

Medicare, Medicaid & Private Payor Updates / By

(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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2023 Webinars

TAHCH Webinar Updates on Vaccine and Mask Mandates Tuesday, January 4, 2023 1 p.m. EST / Noon CST / 10:00 a.m. PST Duration: 60 Minutes Jennifer Papapanagiotou JD, MA Heidi Kocher, JD COVID vaccine and mask mandates have come, been amended, been removed for some occupations or sites and left in place for others. There …

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Civil Investigative Demands (CIDs) & Collateral Enforcement Risks: A Review

Other / By

(October 12, 2022): The False Claims Act is the primary civil enforcement tool utilized by our government today. In Fiscal Year (FY) 2021, the U.S. Department of Justice (DOJ) won or negotiated over $5.6 billion in False Claims Act (FCA)[1] settlements and judgments. Of that amount, more than $5 billion [2] resulted from matters involving …

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Enforcement Efforts Targeting Aquatic Therapy Providers and CPT Code 97113 Claims

Medicare, Medicaid & Private Payor Updates / By

(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 …

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