Medicare, Medicaid & Private Payor Updates

2011: The Year of Compliance – Medicare Payment Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 26, 2011): Medicare payment suspension action can prove disastrous for your practice or home health agency. How did we get to this point? The recent debate over healthcare in this country has drawn attention to healthcare costs as well as the relationship between healthcare providers and the Federal government. With healthcare costs steadily on […]

2011: The Year of Compliance – Medicare Payment Suspension Actions Read More »

2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 11, 2011): ZPIC audits and ZPIC suspension actions are a serious risk facing non-hospital providers today. As you recall at the end of 2010 we identified the “Top Ten Health Care Compliance Risks for 2011”. The purpose of this article is to analyze two of those risks; Zone Program Integrity Contractor (ZPIC) audits and

2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions Read More »

Top Ten Health Care Compliance Risks for 2011

Medicare, Medicaid & Private Payor Updates /

(December 31, 2010): In case you missed it, Congress, President Obama and the healthcare regulators had a banner year with respect to regulatory activism in 2010. Over the next several weeks we will be releasing a series of articles on our website addressing the compliance risk areas facing your organise dramatic changes and the compliance

Top Ten Health Care Compliance Risks for 2011 Read More »

Keeping an Eye on the Medicare AdQIC

Medicare, Medicaid & Private Payor Updates /

(May 16, 2023): The Medicare program is enormous. The Centers for Medicare & Medicaid Services (CMS) estimates that Medicare Administrative Contractors (MAC) process 1.2 billion[1] fee-for-service claims each year in connection with the original[2] (or traditional) Medicare program. If you have ever been involved in a Medicare postpayment audit (or even a prepayment audit[3]) where

Keeping an Eye on the Medicare AdQIC Read More »

Virginia Judge Concludes That Health Care Reform Law is Unconstitutional

Medicare, Medicaid & Private Payor Updates /

(December 13, 2010):  A Federal Judge for the Eastern District of Virginia concluded that the provision of the recent Health Reform Law may be unconstitutional.  that penalizes/taxes individuals who fail to purchase health insurance, violates the United States Constitution.  In doing so, the Court reaches a different conclusion than two other Federal courts – one

Virginia Judge Concludes That Health Care Reform Law is Unconstitutional Read More »

Provider Exclusion Screening / OIG Screening Practices are a Significant Risk

Medicare, Medicaid & Private Payor Updates /

(December 11, 2010): Has your practice conducted exclusion screening / OIG screening on all of you employees?Earlier this week, HHS-OIG announced that it had assessed significant civil monetary penalties against a health care provider that employed seven individuals who the provider “knew or should have known” had been excluded from participation in Federal health care

Provider Exclusion Screening / OIG Screening Practices are a Significant Risk Read More »

HHS Publishes Proposed Rules on Medicaid RACs

Medicare, Medicaid & Private Payor Updates /

(November 30, 2010): The United States Department of Health and Human Services (“HHS”) recently published a Proposed Rule applying the Recovery Audit Contract (RACs) process to claims under the Medicaid program. As background, the RAC process has been a part of the Medicare program since 2005, first as a demonstration project from 2005 – 2008,

HHS Publishes Proposed Rules on Medicaid RACs Read More »

CMS Authorizes Medicare Appeals by Fax and Secured Internet

Medicare, Medicaid & Private Payor Updates /

(November 21, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating that this change

CMS Authorizes Medicare Appeals by Fax and Secured Internet Read More »

Under Health Care Reform Legislation, Stark Law Whole Hospital and Rural Provider Exceptions are Changing

Compliance, Regulatory Issues | Privacy | Other /

(October 22, 2010): It’s not exactly breaking news to anyone in the hospital industry that the U.S. Congress and the regulators at the Center for Medicare and Medicaid Services seem bent on preventing or eliminating physician referrals to hospitals in which they invest. With the passage of health reform legislation in March of this year,

Under Health Care Reform Legislation, Stark Law Whole Hospital and Rural Provider Exceptions are Changing Read More »

HEAT Strike Force Enforcement Takes an International Turn

HEAT Strike Force, Medicare, Medicaid & Private Payor Updates /

(October 17, 2010): Medicare’s HEAT Strike Force is actively tracking down wrongdoers. The FBI has announced the arrest of 73 defendants, a number of which are allegedly members of an international organized crime organization, as part of one of the largest criminal health care fraud cases ever brought. It is estimated that these individuals are

HEAT Strike Force Enforcement Takes an International Turn Read More »