"Nationwide Healthcare Lawyers"
(December 11, 2025): In 1789, when commenting on the newly established U.S. Constitution, Benjamin Franklin famously wrote to French scientist Jean-Baptiste Le Roy that “In this World, Nothing Can be Said to be Certain, Except for Death and Taxes.” [1] In view of the last thirty years of persistent, repeated Medicare audits and investigations, we […]
Responding to Wound Care Audits and Skin Substitute Audits in 2026 Read More »
(September 25, 2025): Medicare providers and beneficiaries will likely face a number of new challenges over the next five years. As you will recall, the Centers for Medicare and Medicaid Services (CMS) Innovation Center has set a goal of having 100% of Traditional Medicare (also commonly referred to as “Original Medicare”) beneficiaries move over to
Overview of the WISeR Model: How Should Your Practice Respond? Read More »
(October 24, 2024): Semaglutide, tirzepatide and a slate of other GLP-1 receptor agonist medications have dominated weight loss headlines in recent years. Not surprisingly, many weight loss providers and clinics have refocused their approaches, incorporating these drugs into patient treatment regimens. Unfortunately, the popularity of these drugs has led to a variety of bad practices,
(January 25, 2024): Although chelation therapy[1] has played an important role in mainstream medicine for many years,[2] it is still considered by many clinicians and regulators to fall within the category of “Complementary and Alternative Medicine.” Proponents of chelation therapy in alternative medicine practices have supported its use in treating Alzheimer’s disease,[3] Parkinson’s disease, multiple
Health Care Provider Risks When Ordering and Billing Chelation Therapy Services Read More »
(November 20, 2023): Medicare, Medicaid, and most private insurance plans cover hospice care and related services. To be eligible for hospice care,[1] a patient must be certified as terminally ill and have a life expectancy of six months or less. In recent years, the hospice industry has exponentially grown, and the number of Federal, State
Hospice Audit and Investigative Actions are Expected to Rise in 2024 Read More »
(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 in the error rate from
Medicare Advantage SIU Audits and Investigations are More Prevalent Than Ever Read More »
(March 30, 2023): On August 16, 2022,[1] President Biden signed the Inflation Reduction Act (IRA) into law, bringing with it plans for broad sweeping changes to tax rates, energy prices, and—most importantly for our purposes — healthcare costs. The general consensus from providers is that because the IRA’s healthcare related provisions address prescription drug costs,
Inflation Reduction Act: What is the Impact on Healthcare Providers? Read More »
(January 26, 2023): Since the inception of the pilot program in 2015, the Targeted Probe and Educate Audit (TPE audit) program has effectively been a double-edged sword for most providers. On the positive side, it has served as an educational tool that providers can use to better ensure that their medical necessity, documentation, coding and
TPE Audits: The Process & Expected Targets in 2023 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
By Michael Cook, Jennifer Papapanagiotou & Andy Lynch – Partners at Liles Parker, PLLC. (March 31, 2020): On March 27, 2020, the Coronavirus Aid, Relief and Economic Security (CARES) Act[1] passed the House of Representatives by a voice vote. The President then signed the bill into law. The bill is the third round of federal
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