Search Results for: Special Investigations Unit

SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment.  Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant?

Dental Audits & Compliance /

(October 16, 2019): A Federal District Court Judge recently sentenced a Murfreesboro, TN dentist to prison and ordered that he pay restitution to TennCare (Tennessee’s Medicaid program). Regrettably, the types of improper billing practices cited by the government in the criminal Information filed against the defendant dentist aren’t that uncommon. This recent prosecution serves as […]

SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment.  Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant? Read More »

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements?

Dental Audits & Compliance /

(January 3, 2019): Slowly but surely, the percentage of adults and children with dental insurance coverage benefits has gradually climbed. These increases have been driven, at least in part, by several factors. First, despite the fact that traditional Medicare does not cover routine dental services, a number of Medicare Advantage plans are now offering coverage

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements? Read More »

The OPM Debarment Action on Health care Providers - Liles Parker - Dec 2023

The OPM Debarment Process – Responding to an FEHBP Debarment or Suspension Action in 2024

Regulatory Issues | Privacy | Other /

Author: Ashley Morgan, Christin Thompson (December 20, 2023): Most health care providers and suppliers are familiar with the fact that as a participating provider in the Medicare and / or Medicaid programs, certain criminal convictions, adverse licensure actions, and various types of prohibited conduct may subject the provider to exclusion from participation in Federal health

The OPM Debarment Process – Responding to an FEHBP Debarment or Suspension Action in 2024 Read More »

Hospice Audit and Investigative Actions are Expected to Rise in 2024 - November 2023

Hospice Audit and Investigative Actions are Expected to Rise in 2024

Featured, Home Health & Hospice /

(November 20, 2023): Medicare, Medicaid, and most private insurance plans cover hospice care and related services. To be eligible for hospice care,1 a patient must be certified as terminally ill and have a life expectancy of six months or less.  In recent years, the hospice industry has exponentially grown, and the number of Federal, State

Hospice Audit and Investigative Actions are Expected to Rise in 2024 Read More »

AI in medical billing- Liles Parker - October 2023

AI in Medical Billing: A Benefit or a Compliance Risk?

Regulatory Issues | Privacy | Other /

Author: Christin Thompson, Annabella Denzel (October 10, 2023): In terms of revenues and expenses, health care providers and suppliers have repeatedly faced two unfortunate realities: (1) Reimbursement rates are shrinking, and (2) they are constantly being saddled with additional unfunded mandates (for example, HIPAA compliance, OSHA requirements, compliance obligations, etc. Coupled with ordinary practice expenses,

AI in Medical Billing: A Benefit or a Compliance Risk? Read More »

Medicare Exclusion Risks: Employing Excluded Individuals Can Result in Significant Administrative, Civil and / or Criminal Liabilities

Medicare, Medicaid & Private Payor Updates /

(May 8, 2023): One of the most severe administrative sanctions available under the Social Security Act stems from the authority of the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS)[1] to “exclude” individuals and entities from participating in Federal health care programs.[2] While the Centers for Medicare and

Medicare Exclusion Risks: Employing Excluded Individuals Can Result in Significant Administrative, Civil and / or Criminal Liabilities Read More »

Enforcement Efforts Targeting Aquatic Therapy Providers and CPT Code 97113 Claims

Medicare, Medicaid & Private Payor Updates /

(October 3, 2022): Aquatic therapy is a common method of rehabilitation and maintenance for several types of injuries and conditions, and the practice is widely accepted by Medicare, Medicaid and many private payors. Historically, both payors and law enforcement have routinely audited aquatic therapy claims. The Centers for Medicare and Medicaid Services (CMS) initially suspended

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Incident To Billing Practices are Under Law Enforcement’s Microscope. Are Your Incident To Billing Practices Compliant?

Medicare, Medicaid & Private Payor Updates /

(September 20, 2022): In the Medicare billing context, the term “Incident To” refers to the fact that under certain circumstances, the services of non-physician, mid-level practitioners (such as Nurse Practitioners (NPs) and Physician Assistants (PAs)) are “. . . furnished as an integral, although incidental, part of the physician’s personal professional services in the course

Incident To Billing Practices are Under Law Enforcement’s Microscope. Are Your Incident To Billing Practices Compliant? Read More »

laws regulation changes affect billing agreement - Liles Parker

Ever-Changing Federal and State Laws and Regulations are Transforming Third-Party Billing Contracts

Regulatory Issues | Privacy | Other /

(July 28, 2022): The business side of medicine has changed considerably over the last decade. Health care laws, regulations, and administrative policies are constantly evolving. A number of these changes have impacted health care practices, billing companies, and the third-party billing contracts executed between these parties. From its earliest beginnings, the majority of third-party billing

Ever-Changing Federal and State Laws and Regulations are Transforming Third-Party Billing Contracts Read More »