Medicare, Medicaid & Private Payor Updates

Veterans Administration and CMS Announce Partnership to Address Fraud Prevention

Medicare, Medicaid & Private Payor Updates /

(January 25, 2018): On January 23rd, the Veteran Administration (VA) and the Centers for Medicare and Medicaid Services (CMS) announced a “partnership to strengthen prevention of fraud, waste and abuse.” According to the press release, under this partnership: “VA plans to capitalize on the advancement in analytics CMS has made by concentrating on its use […]

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Revocation of Your Medicare Billing Privileges

Medicare, Medicaid & Private Payor Updates /

(December 14, 2017): The Centers for Medicare and Medicaid Services (CMS) has engaged various types of outside contracting entities to perform program integrity functions on behalf of the Medicare program. At the present time, Uniform Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs) are very aggressive when it comes to referring evidence of

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UPIC / ZPIC Referrals to State Boards, Societies, Surveyors and QIOs

Medicare, Medicaid & Private Payor Updates /

(November 29, 2017): The Medicare and Medicaid programs are managed by the Centers for Medicare and Medicaid Services (CMS). CMS has engaged Unified Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs), among others, to provide program integrity support. In the course of their duties, UPICs and ZPICs may initiate a prepayment review, postpayment

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Pain Management Prescribing Practices and Audits.

Medicare, Medicaid & Private Payor Updates /

(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct (additional arrests were made in the days following the takedown).  As Attorney General Jeff Sessions stated at

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Maryland Limits on Opioid Prescriptions

Medicare, Medicaid & Private Payor Updates /

(June 30, 2017): In March 2016, the Centers for Disease Control and Prevention (CDC) published “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016” [1] in an effort to address the seemingly ever-increasing deaths that have been attributed to opioid-related overdose. A number of states have passed legislation or enacted regulatory provisions

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Indiana Opioid Prescribing Guidelines–Eff. July 1, 2017.

Medicare, Medicaid & Private Payor Updates /

(June 29, 2017): Deaths resulting from a drug overdose have grown considerably in recent years. The results of a study published in “Morbidity and Mortality Weekly Report” by the Centers for Disease Control and Prevention (CDC) found that 63.1% of the overdose-related deaths in 2015 involved opioids. Notably, this was a significant increase from the

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Opioid Prescribing Practices & NBI MEDIC / UPIC / ZPIC and Board Actions

Medicare, Medicaid & Private Payor Updates /

(June 29, 2017): It has been estimated that from 1999 to 2014, more than 165,000 persons died from an overdose of opioid medications in the United States. Researchers also noted that during this same time period, sales of opioids increased in proportion to the rise in deaths resulting from an opioid-related overdose. In an effort

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NBI MEDIC Referrals to Boards, OIG and DOJ are Here!

Medicare, Medicaid & Private Payor Updates /

(June 28, 2017): The Medicare program is enormous. As of 2016, more than 56 million individuals participated in the program, with more than 10,000 additional individuals enrolling in the program each day. The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for managing this costly program. To direct this $640 billion program,

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UPIC / ZPIC / Health Integrity Opioid Audits and Audits of Other High Risk Drugs.

Medicare, Medicaid & Private Payor Updates /

(June 23, 2017): Opioid audits of the prescribing practices of pain management physicians are on the rise. As the Department of Health and Human Services (HHS), Office of Inspector General (OIG), noted in its report “High Part D Spending o Opioids and Substantial Growth in Compounded Drugs Raise Concerns,” 30% of Medicare beneficiaries have at

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False Claims Act Penalties Have Almost Doubled!

Medicare, Medicaid & Private Payor Updates /

(June 21, 2017): Over the last year, the False Claims Act penalties have almost doubled. This is especially important when you consider the fact that the False Claims Act is the primary civil enforcement tool used by the U.S. Department of Justice to fight fraud committed against government programs by individuals and entities. Often referred

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