Search Results for: private overpayment

Medicare Dental Audits are Being Conducted by ZPICs. Is Your Specialty Dental Practice Ready?

(January 18, 2013): Specialty dental practices around the country are receiving audit letters from “Zone Program Integrity Contractors” (ZPICs), contractors working for the Centers for Medicare and Medicaid Services (CMS). This latest audit focus by ZPICs is rather surprising in light of the fact that very few dental procedures qualify for Medicare coverage and payment. […]

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The Recovery Audit Contractor Program Continues to Expand its Medicare Footprint

(November 26, 2012): The Medicare Fee-for-Service (FFS) program consists of numerous payment systems, with a complex network of contractors that process more than one billion claims submitted by more than one million healthcare providers each year.[1] Medicare providers include hospitals, physicians, skilled nursing facilities, labs, ambulance companies, and durable medical equipment, prosthetics, orthotics, and supplies

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Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers

(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were

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Texas Medicaid Dental Claims Are Under Audit Scrutiny

(April 23, 2012): Texas dentists, orthodontists and oral surgeons are under considerable scrutiny by the government, and most practices don’t even realize it. This article examines several one of the current tools being used by the government to calculate the alleged amount of “damages” (improper claims) paid to dental providers by the State under Medicaid.

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Conducting a Gap Analysis / Mock Audit: An Essential Compliance Tool for Your Practice

(November 15, 2011): Understandably, health care providers have grown weary of government audits, malpractice issues, peer reviews and private payor assessments. In an effort to reduce their potential liability, many providers are now regularly utilizing Gap Analyses / Mock Audits to test their preparedness for audit. In doing so, they have been able to identify

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Health Integrity Audits of Texas and Oklahoma Home Health Agencies are on the Rise.

(August 14, 2011): Home health agencies in Texas and Oklahoma remain under considerable scrutiny by Medicare contractors tasked with identifying fraud and abuse perpetrated against the Medicare Trust Fund. As discussed below, these Medicare contractors have a number of tools at their disposal, many of which can effectively place a home health agency in financial

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Top Ten Health Care Compliance Risks for 2011

(December 31, 2010): In case you missed it, Congress, President Obama and the healthcare regulators had a banner year with respect to regulatory activism in 2010. Over the next several weeks we will be releasing a series of articles on our website addressing the compliance risk areas facing your organise dramatic changes and the compliance

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HHS Publishes Proposed Rules on Medicaid RACs

(November 30, 2010): The United States Department of Health and Human Services (“HHS”) recently published a Proposed Rule applying the Recovery Audit Contract (RACs) process to claims under the Medicaid program. As background, the RAC process has been a part of the Medicare program since 2005, first as a demonstration project from 2005 – 2008,

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DOJ is Using Medicare Billing Data to Target Health Care Providers

(August 31, 2010): Last week, department heads of the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS), met in Los Angeles, CA and conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” Following-up on a similar conference held in Miami, DOJ Attorney General Eric

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