"Nationwide Healthcare Lawyers"
(February 24, 2015): Medicare recently finalized regulations allowing enrollment as a Medicare provider to be denied if any owner or control person of the enrolling provider is affiliated with another provider which owes money to Medicare. These regulations are based on sections of the 2010 Affordable Care Act (ACA). They provide CMS an indirect means […]
Individual Liability for Medicare Overpayment Claims Read More »
(August 31, 2014): The Healthcare Quality Improvement Act of 1986[1] (“HCQIA”, generally pronounced “Hick Kwah”), affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. Unfortunately, the provider peer review process is irrevocably
Peer Review: How HCQIA Due Process is a Fiction Read More »
(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative
Medicare ALJ Appeals of Denied Home Health Claims Read More »
(September 20, 2013): Like other physicians around the country, Texas physicians are currently facing increasing pressures to ensure that their medical necessity determinations, coverage assessments, documentation, coding and billing activities meet both Medicare’s requirements and those of private payors. While their duties and responsibilities have continued to increase, reimbursement rates have steadily fallen. Notably, Texas
Texas Medical Board Complaints are Serious Business! Read More »
(August 26, 2013): Medicare compliance challenges have increased (rather than decreased) with the passage of the Affordable Care Act and the implementation of Electronic Medicare Records (EMR) systems by physicians and other health care providers around the country. Late last week, Robert W. Liles, Managing Partner at Liles Parker, had the privilege of serving as a
Liles Parker Attorney Presented at the West Virginia Physician Summit Read More »
(July 3, 2013):Everyone reading this article is likely familiar with the phrase “You have the right to remain silent.” In fact, a citizen’s right to remain silent is considered the cornerstone of an individual’s Fifth Amendment right against self-incrimination. As you may recall, the Fifth Amendment to the Constitution provides: “No person shall be held
“Under the Fifth Amendment, You Have the Right to Remain Silent.” Well. . . Maybe Not. Read More »
(February 10, 2013): Texas physicians face a myriad of challenges each and every day. In an era when reimbursement rates are declining yet many expenses are continuing to rise, physicians are also seeing many of their services co-opted by physician assistants and nurse practitioners, thereby further increasing competitive pressures. Unfortunately, these challenges only represent the
(October 19, 2012): This article addresses the case where an individual or “natural person” owns an interest in a Medicare health care provider which is incorporated[1] under the laws of a state, as a corporation, limited liability company, limited partnership, or another type of legal person. The individual may be a shareholder, member, limited partner,
Individual Liability for Medicare Overpayment Claims Read More »
(May 24, 2012): The Centers for Medicare & Medicaid Services (CMS) is rolling out a new survey initiative, known as the “National Site Visit Contractor” program. In updates to the Medicare Program Integrity Manual released on April 6, 2012 and April 13, 2012, CMS has somewhat quietly introduced the National Site Visit Contractor program, noting
National Site Visit Contractor Established Read More »
(February 7, 2012): In recent years, physicians and other health care providers have faced a wide number of administrative actions and sanctions levied by contractors working for the Centers for Medicare and Medicaid Services (CMS). Zone Program Integrity Contractors (ZPICs) have subjected physician practices to Medicare prepayment reviews, postpayment audits, suspension and / or revocation
RAC-Initiated Medicare Prepayment Reviews Will Soon Begin. Read More »