Medicare, Medicaid & Private Payor Updates

South Texas Medicare Providers are Under the ZPIC Microscope

Medicare, Medicaid & Private Payor Updates /

(July 16, 2010): If there were ever any doubts that ZPICs are going to make their presence known in South Texas now that they have replaced PSCs,those doubts can be put to rest. Health Integrity LLC, the Zone 4 contractor, is proving to be an active and aggressive auditor of physician practices, physical therapy services, […]

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Providers Should Exercise Caution When Handling Overpayments — More Than Likely, You Can’t Keep It, Even if the Payor Doesn’t Want it Back!

Medicare, Medicaid & Private Payor Updates /

(July 15, 2010): When handling Medicare overpayments, providers must exercise caution. Since the May 2009 passage of the Fraud Enforcement and Recovery Act (FERA) and subsequent enactment of the Affordable Care Act (ACA), we’ve heard a lot about how the government looks at Medicare overpayments and how providers should handle them. Prior to the clarification

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Can a ZPIC Extrapolate the Alleged Damages in a Medicare Claims Audit?

Medicare, Medicaid & Private Payor Updates /

(July 12, 2010): Can a ZPIC extrapolate the alleged damages in a case. If the ZPIC’s statistical methodology is properly handled, the extrapolation of alleged damages can be a surefire way of destroying a provider’s practice. We’ve known it for years and yet the government’s passion for statistical sampling only seems to be growing. This

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ACA Reporting and Repayment Mandates are a Real Minefield for Medicare Providers.

Medicare, Medicaid & Private Payor Updates /

(July 9, 2010): Does the failure to promptly return a Medicare overpayment really warrant liability under the False Claims Act (FCA)? Congress thinks so. The Patient Protection and Affordable Care Act (also known as the “Affordable Care Act” or “ACA”) creates an obligation under the FCA whereby a Medicare provider who fails to timely report

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Identity Theft — Red Flags Rule — Treating Doctors Like Banks Is Delayed Once Again

Compliance, Medicare, Medicaid & Private Payor Updates /

(July 5, 2010): The Federal Trade Commission (FTC) has agreed to once again delay enforcement of its illogical and onerous identity theft Red Flags rule with respect to physicians.The Red Flags rule arose under the Fair and Accurate Credit Transactions Act of 2003 and requires “financial institutions” and “other creditors” to develop written plans to

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Enactment of Doc Fix Bill Offers Another Temporary Reprieve for Medicare Physicians

Medicare, Medicaid & Private Payor Updates /

(June 28, 2010): On Friday, June 25, 2010, President Obama signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962), commonly referred to as the Doc Fix, which provides yet another band-aid for our broken Medicare physician pay system. The bill replaces the 21% Medicare physician payment

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GAO Testimony Recommends CMS Improve Enrollment, Payment, and Oversight Procedures

Medicare, Medicaid & Private Payor Updates /

(June 23, 2010): Yesterday we told you about recent GAO testimony before Congress regarding the impact of health care reform on HHS enforcement efforts. On the same day, GAO Health Care Director Kathleen M. King offered Congress testimony that made clear that the Centers for Medicare & Medicaid Services (CMS) continue to face substantial challenges

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President Obama Publicizes Measures to Reduce Medicare Improper Payment Rate

Medicare, Medicaid & Private Payor Updates /

(June 8, 2010): For those of you who missed the first two dozen pronouncements (okay, perhaps a little exaggerated, but still . . . we got the message when Congress made it a False Claims Act violation to hold onto a mere overpayment for more than 60 days), President Barack Obama has again expressed his

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Responding to a Search Warrant Executed at Your Health Care Practice or Clinic

Medicare, Medicaid & Private Payor Updates /

(June 1, 2010): Like most honest health care providers, you may believe that search warrants are only executed by the government in connection with the investigation of nefarious characters and criminals. Unfortunately, that just isn’t the case. The Federal government has increasingly utilized search warrants as a first-strike investigative tool. In fact, the execution of

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HHS-OIG Reports that Four Medicaid Audit Error Types Accounted For 95% of the Net Improper Medicaid Overpayments

Medicare, Medicaid & Private Payor Updates /

(April 20, 2010): The Department of Health and Human Services, Office of Inspector General (OIG) recently released its report on Medicaid Audits “HHS-Analysis of Improper Payments Identified During the Payment Error Rate Measurement Program Reviews in 2006 and 2007 (A-06-09-00079).” As set out in the report, four types of medical review errors accounted for 95%

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