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Additional Cities will have HEAT Teams in 2011

(August 27, 2010): Additional cities will be getting Medicare fraud HEAT teams. Yesterday, Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” In addition to these agency heads, participants learned of current and […]

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What Can Cities Do About Dangerous Buildings?

(June 25, 2010): Cities have the authority, usually provided by State statute, to regulate dangerous and substandard buildings and structures. In Texas, a City has to pass an ordinance to activate its ability to regulate dangerous buildings and structures. See TEX. LOC. GVT CODE § 214 Subchapter A. Before taking action against a dangerous building,

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Don’t Take ZPIC Extrapolation Calculations at Face Value

(July 14, 2010): Imagine a Zone Program Integrity Contractor (ZPIC) handing you a claim analysis rife with alleged errors, an indecipherable list of statistical formulae, and an extrapolated recovery demand that will cripple your practice or clinic. What steps should you take to analyze their work? Based on our experience, providers can and should carefully

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President Obama Appoints Dr. Donald Berwick as the New Head of CMS.

(July 7, 2010): Earlier today, President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). He was nominated on April 19, 2010. According to the White House’s press release, Dr. Berwick is a pediatrician, Harvard University professor, and President and Chief Executive

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A Look at RACs — Part III: What Medicare Providers Know about RAC Audit Recoupment Rules.

(July 2, 2010): The Centers for Medicare and Medicaid Services (CMS) audit program involving Recovery Audit Contractors (RACs) is now permanent and nationwide. As we discussed in Part I of this series, while small providers were largely ignored during the demonstration program, physicians, home health, hospice, and durable medical equipment (DME) suppliers should be on

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A Look at RACs — Part II: How Should Physicians and Other Providers Respond to a RAC Audit?

(June 29, 2010): In Part I of this series, we reacquainted you with the design and purpose of the now permanent Recovery Audit Contractor (RAC) Program. Although RACs largely focused on inpatient care during CMS’ demonstration program, RACs are a real threat to small providers that don’t have the intensive compliance programs in place that

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Part III: Issues When Dealing with a Failed Corporation — Analysis and Conclusion

(April 26, 2010): Part III: Analysis and Conclusion In the midst of an economic downturn, headlines are filled with accounts of failed corporations and bankruptcies as well as notorious government bailouts. There are many threatened lawsuits directed at officers and Directors of corporations for breaches of their fiduciary duties or seeking judicial declarations that corporations

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