"Nationwide Health Care Lawyers"
(January 26, 2021): Under the Anti-Kickback Statute (Anti-Kickback Statute), what constitutes a referral? Notably, neither the term referral nor the term referring (as it is referred to in the law) are defined in the statute. While you may be tempted to argue that a referral only occurs when one party refers a beneficiary to another party for …
What is a Referral Under the Anti-Kickback Statute? Read More »
(January 19, 2021): As you will recall, on March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) suspended most Medicare audits and reviews due to the COVID-19 national emergency. In early August, CMS instructed its contractors to resume their prepayment and postpayment audit activities. Over the last six months, we have seen a …
(January 13, 2021): Over the last few years, we have noted a significant increase in the number of audits initiated against Chiropractor owned multidisciplinary practices. Typically, these integrated medical practices and clinics employ at least one Chiropractor (typically in an ownership or managerial capacity), along with multiple Doctors of Medicine (MDs), Doctors of Osteopathy (DOs). …
Chiropractor Owned Multidisciplinary Practices are at a Higher Risk of Audit Read More »
(Updated January 9, 2021): Owners of healthcare companies often wonder whether the government can pierce the corporate veil and try to hold the owners personally liable for overpayment claims when facing a program integrity audit by a Unified Program Integrity Contractor (UPIC). [1] This rarely happens, but assuming that a provider does not prevail in …
Pierce the Corporate Veil — Are You Personally Liable for a UPIC Overpayment? 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 »
(January 3, 2021): In recent months, we have seen a significant rise in the number of Medicare and Medicaid audits focusing on the medical necessity of certain outpatient Respiratory Viral Panels (CPT Code 87633) and Gastrointestinal Pathogen Panels (CPT Code 87507). Unfortunately, many of these audits seem to be merely the latest example where payors …
Audits of Respiratory (CPT Code 87633) / Gastro (CPT Code 87507) Panels are Ongoing. Read More »
(December 28, 2020): Let’s face it, we are all glad to have 2020 behind us. From an enforcement standpoint, COVID-19 greatly impeded the Federal government’s ability to investigate and prosecute civil and criminal violations of law. The numbers speak for themselves. Between February 2020 and April 2020, new criminal prosecutions had dropped by 80%.[1] Although …
A Look Back at Hospice Audits and Prosecutions in 2020 — Are You Ready for 2021? Read More »
(November 11, 2020): If you run a nonprofit company that contracts with the federal government through the AbilityOne Program, then you should be aware that inadequate compliance policies could put your nonprofit in danger of facing allegations of waste, fraud, abuse, and mismanagement, onerous audits and investigations, and even civil liability. Under the AbilityOne Program, …
AbilityOne OIG Audits are Ramping-Up! Is Your Nonprofit Agency Ready for an Audit? Read More »
(September 28, 2020): Last September, CMS published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” [1] Among its many changes, the Final Rule significantly expanded the reasons that may be asserted by the Centers for Medicare and Medicaid Services (CMS) when revoking a health …
Home Health Revocation Actions by Medicare are Expanding Around the Country Read More »
(September 25, 2020): In recent years, many individuals (especially younger members of our work force) have embraced the chance to supplement their income through short-term engagements in the “gig economy.” Notably, both professionals and non-professionals alike have found flexible, part-time opportunities online, allowing them to work remotely as independent contractors. A number of physicians, nurse …
Medicare Revocation Actions Related to Telemedicine Rising! Read More »