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Small Business Administration Releases Express Bridge Loan Pilot Program for COVID-19

COVID-19 Updates, Medicare, Medicaid & Private Payor Updates /

(March 26, 2020): The Small Business Administration (“SBA”) announced an Express Bridge Loan Pilot Program on March 25, 2020.[1] The Express Bridge Loans are available to businesses, including health care providers, to provide economic relief for businesses impacted by the Coronavirus Disease (COVID-19) while they await long-term disaster financing.[2] I. Background: The Express Bridge Loan […]

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COVID-19 SBA Loan Support May be Available for Qualified Health Care Providers

COVID-19 Updates, Medicare, Medicaid & Private Payor Updates /

(March 25, 2020): The Small Business Administration (SBA) offers loans to small businesses through community lenders. The SBA acts as guarantor for these loans. In addition to the traditional lending, the SBA is also authorized to offer disaster assistance to businesses, renters, and homeowners who are located in regions with “declared disasters.”[1] Small businesses impacted

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Overview of Dental Claims Audits and Investigations by Medicaid and Private Payors in 2019

Dental Audits & Compliance /

(March 4, 2020): Many dentists and dental practices around the country are glad that 2019 is behind us.  Last year was a banner year for law enforcement investigators and administrative auditors of dental claims.  Federal and State prosecutors around the country actively pursued both civil and criminal cases against individual dentists for a variety of

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Telemedicine Audits of Evaluations by Referring Physicians are Increasing

Medicare, Medicaid & Private Payor Updates /

(February 17, 2020): Over the last few months, we have seen a significant increase in the number of telemedicine audits and investigations by law enforcement and program integrity contractors.  Unfortunately, most of the calls we have received have been from physicians who have inadvertently become associated with a number of improper telemedicine schemes.  The purpose

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Providers Should Ensure That They Are Fully Aware of All of the Collateral Consequences that May Occur When Settling with the Government

Medicare, Medicaid & Private Payor Updates /

(December 2, 2019): Over the past several years, several clients have come to our Firm who have resolved disputes through such mechanisms as settlement agreements, criminal pleas, or consent orders, either because they specified minimal penalties or because they did not include any time in incarceration. Later they discover that agreeing to these resolutions has

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What is the CMS Preclusion List? What is the Difference Between an Exclusion and a Preclusion Action? How Can You Appeal a CMS Preclusion Action?

Medicare, Medicaid & Private Payor Updates /

(October 8, 2019): On April 16th, 2018, the Department of Health & Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), issued a Final Rule entitled, “Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program.”

What is the CMS Preclusion List? What is the Difference Between an Exclusion and a Preclusion Action? How Can You Appeal a CMS Preclusion Action? Read More »

DEA Audits / DEA Registration Defense / DEA Enforcement Actions

The Drug Enforcement Administration (DEA) was first established in 1973[1] and is an investigative / enforcement component of the U.S. Department of Justice.  The DEA is the primary federal agency that has been tasked with the enforcement of laws governing the illegal sale, distribution, manufacturing or use of drugs.  The primary statute enforced by the

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UPIC Dental Audits (Such as Qlarant Dental Audits) Have Been Initiated. Is Your Practice Ready for its Medicare Dental Claims or Medicaid Dental Claims to be Audited?

Dental Audits & Compliance /

(July 3, 2018): While a number of Medicare Advantage Plans now offer supplemental coverage for preventive, basic, and major dental services, only a narrow category of dental services qualify for coverage and payment under standard Medicare Part A (pursuant to Section 1862(a)(12) of the Social Security Act). Presently, only qualifying Medicaid beneficiaries are likely to

UPIC Dental Audits (Such as Qlarant Dental Audits) Have Been Initiated. Is Your Practice Ready for its Medicare Dental Claims or Medicaid Dental Claims to be Audited? Read More »