"Nationwide Healthcare Lawyers"
(August 3, 2026): Pain has become a place where medicine, law, and patient needs collide. Chronic pain is not a marginal public-health issue. In its most recent survey, the Centers for Disease Control and Prevention (CDC) estimated that 60 million adults, nearly 1 in 4, in the United States suffer from chronic pain. More than […]
The Criminalization of Pain: The Risks of Prescribing Controlled Substances Read More »
(July 15, 2026): For health care practitioners, providers, and suppliers, the National Practitioner Data Bank (NPDB) represents one of the most significant and least understood forces in their professional lives. What began as an effort by Congress to track incompetent physicians has evolved into a massive, permanent repository of medical malpractice payments, disciplinary actions, and
A Negative NPDB Report Can End Your Career— Know Your Rights Read More »
(December 20, 2023): Most health care providers and suppliers are familiar with the fact that as a participating provider in the Medicare and / or Medicaid programs, certain criminal convictions, adverse licensure actions, and various types of prohibited conduct may subject the provider to exclusion from participation in Federal health care programs[1] by the Department
(June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million[1] Texans (approximately 18.9% of the current population[2]) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40
(June 15, 2023): The Department of Health and Human Services (HHS) is enormous, employing more than 80,000 individuals[1] who work in a dozen operating divisions and an even greater number of independent offices that report directly to the Office of the Secretary.[2] One of these independent offices is the HHS Departmental Appeals Board (DAB or
HHS Departmental Appeals Board (DAB) Appeals Read More »
(May 25, 2023): According to the latest data released by the Centers for Medicare and Medicaid Services (CMS), beneficiaries participating in Medicare Advantage[1] plans now surpass those enrolled in original Medicare plans. Slightly more than one-half[2] of the 59.82 million Medicare beneficiaries now eligible for coverage have signed up for one of the 5,261 Medicare
(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
Civil Investigative Demands (CIDs) & Collateral Enforcement Risks: A Review 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 »
(September 20, 2022): In the Medicare billing context, the term “Incident To” refers to the fact that under certain circumstances, the services of non-physician, mid-level practitioners (such as Nurse Practitioners (NPs) and Physician Assistants (PAs)) are “. . . furnished as an integral, although incidental, part of the physician’s personal professional services in the course
(May 25, 2022): In recent years, federal regulators have initiated a significant number of audits and investigations examining the improper billing of claims for balloon sinuplasty / balloon dilation procedures by Otolaryngologists (commonly referred to as Ear, Nose and Throat (ENT) physicians. Depending on the specific facts in each case, the improper billing of balloon
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