"Nationwide Healthcare Lawyers"
Wednesday, December 2nd, 2020 1 p.m. EST / Noon CST / 10:00 a.m. PST OIG Work Plan 2021 – Is Your Home Health, Hospice or Personal Care Agency in the Government’s Crosshairs? The Office of Inspector General’s “Work Plan” is its general audit and investigative plan for the upcoming year. The publication of OIG’s Work […]
2020 TAHCH webinar Read More »
Robert W. Liles has worked in regulatory compliance as a Federal prosecutor and as defense counsel, for more than 25 years. This has provided a unique perspective on the challenges faced by clients in highly regulated industries such as health care, banking and finance. Mr. Liles focuses his practice on fraud defense, internal audits, investigations,
Robert W. Liles, J.D., M.B.A., M.S. Read More »
In 1996, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) first estimate the improper payment error rate of Medicare Fee-For-Service (FFS) claims. [1] From 1996 through 2002, OIG continued to manage this program. In 2002, the Improper Payments Information Act (IPIA) was enacted.[2] Under the IPIA, Federal agencies, including HHS
(January 13, 2021): Over the last few years, we have noted a significant increase in the number of audits initiated against Chiropractor owned multidisciplinary practices. Typically, these integrated medical practices and clinics employ at least one Chiropractor (typically in an ownership or managerial capacity), along with multiple Doctors of Medicine (MDs), Doctors of Osteopathy (DOs).
Chiropractor Owned Multidisciplinary Practices are at a Higher Risk of Audit Read More »
Last month, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare fee-for-service improper payment rate had declined from 11% in Fiscal Year (FY) 2016 to approximately 6.27% in FY 2020. [1] Despite the fact that real progress in reducing the amount of improper Medicare payments has been made, health care fraud, waste
Special Investigative Unit (SIU) Audits Read More »
Today, it is more essential than ever that health care providers take great care when assessing a patient’s clinical needs and determining which care and treatment is medically necessary. Once this decision is made, it is imperative that health care providers submitting claims to governmental and private payors fully understand their obligations under the law
Eight Elements of a Payable Medical Claim Read More »
Ashley Morgan is a partner at Lliles Parker. She focuses her practice on regulatory health care compliance matters, fraud and abuse, and reimbursement issues. Ms. Morgan represents health care providers across the country in connection with a wide variety of health law issues including coverage disputes, documentation concerns, compliance, medical board complaints, and exclusion /
Ashley Morgan, J.D. Read More »
The civil False Claims Act [1] (31 U.S.C. §§ 3729-3733), is the primary civil health care fraud enforcement tool utilized by the federal government. As discussed below, the False Claims Act is an extraordinarily useful statute for government prosecutors, both in terms of ease of use and in terms of the damages that may be
False Claims Act Matters and Cases — An Overview Read More »
(January 3, 2021): In recent months, we have seen a significant rise in the number of Medicare and Medicaid audits focusing on the medical necessity of certain outpatient Respiratory Viral Panels (CPT Code 87633) and Gastrointestinal Pathogen Panels (CPT Code 87507). Unfortunately, many of these audits seem to be merely the latest example where payors
Audits of Respiratory (CPT Code 87633) / Gastro (CPT Code 87507) Panels are Ongoing. Read More »
The False Claims Act (31 U.S.C. §§ 3729-3733), was first enacted in 1863 by a Congress concerned that suppliers of goods to the Union Army during the Civil War were defrauding the Army. Over the life of the statute it has been interpreted on hundreds of occasions by Federal courts (which have sometimes issued conflicting
False Claims Act Matters and Cases Read More »
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