"Nationwide Healthcare Lawyers"
(January 21, 2026): The past year has been rough for many dental practices around the country. After declining during COVID, government and private payor audits of dental claims rose sharply in 2024 and continued to increase in 2025. The question we are now being asked by our dental clients is whether these activities will continue […]
Dental Claim Audits and Investigations are Expected to Increase in 2026 Read More »
(January 13, 2026): As the great Yogi Berra once said, “It’s tough to make predictions – especially about the future.” This maxim is especially true when it comes to forecasting the specific dental claim risk issues that will be the focus of private payor Special Investigation Units (SIUs) in 2026. Nevertheless, we are going to
Delta Dental Audits Will Increase in 2026. Is Your Practice Ready? Read More »
(December 18, 2025): Laboratory Polymerase Chain Reaction (PCR) testing for urinary tract infections (UTIs) offers rapid, sensitive pathogen detection but often presents complex coding and billing challenges for Medicare providers and laboratories. Medicare contractors are increasingly denying UTI test claims due to issues with medical necessity, documentation, and improper coding/billing practices. Robust compliance and up-to-date
Responding to Medicare Audits of PCR Testing for UTIs in 2026 Read More »
CMS UPDATE – DECEMBER 24, 2025 “Effective immediately, CMS’ A/B Medicare Administrative Contractors (MACs) are withdrawing the Local Coverage Determinations (LCDs) for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers that were scheduled to become effective on January 1, 2026.” ORIGINAL ARTICLE (December 11, 2025): In 1789,
Responding to Wound Care Audits and Skin Substitute Audits in 2026 Read More »
(December 09, 2025): The Government Accountability Office (GAO) has long expressed concerns regarding the fraud, waste and abuse risks inherent in the Medicare program. In fact, GAO first designated Medicare as a “High Risk” program due to its size, complexity and susceptibility to improper payments.[1] Throughout 2025, Medicare providers and suppliers were subjected to significant
Prior Authorization Demonstration Audits for Certain ASC Services Start in January 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 10, 2024): Ketamine has been in the news again lately. . . for all the wrong reasons. In August 2024, Federal prosecutors out of the Central District of California announced the indictment of five individuals, including two physicians, who allegedly played a role in the fatal ketamine overdose of Matthew Perry in October 2023.
(August 14, 2024): For almost a century, health care providers have used amniotic tissues / amniotic membranes in the care and treatment of wounds.[1] In recent years, health care providers have greatly expanded the scope of therapeutic applications employing amniotic tissues / amniotic membranes in wound care procedures. These developments have led to increased scrutiny
(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 »
(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