Search Results for: private overpayment

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

Medicare, Medicaid & Private Payor Updates /

(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.

Home Health & Hospice /

(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

Medicare, Medicaid & Private Payor Updates /

(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

Medicare, Medicaid & Private Payor Updates /

(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

Medicare, Medicaid & Private Payor Updates /

(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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President Obama Publicizes Measures to Reduce Medicare Improper Payment Rate

Medicare, Medicaid & Private Payor Updates /

(June 8, 2010): For those of you who missed the first two dozen pronouncements (okay, perhaps a little exaggerated, but still . . . we got the message when Congress made it a False Claims Act violation to hold onto a mere overpayment for more than 60 days), President Barack Obama has again expressed his

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Is a ZPIC Tougher than a RAC or PSC When Conducting Medicare Audits?

Medicare, Medicaid & Private Payor Updates /

(March 25, 2010): The Recovery Audit Contractor (RAC) program is an integral part of the Centers for Medicare & Medicaid Services’ (CMS’) “benefit integrity” efforts which seek to identify and recoup alleged overpayments paid to Medicare providers. Similarly, Program SafeGuard Contractors (PSCs) have been actively auditing Medicare providers and suppliers around the country. While the

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David P. Parker, J.D., B.A.

David Parker practices in the business transaction and healthcare areas. His business practice includes overseeing all legal aspects of private debt and equity financings and the purchase and sale of businesses. Mr. Parker represents buyers and sellers in the purchase or sale of business operations and entities. Mr. Parker has experience in originating, syndicating, closing,

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Compliance Program Development and Implementation

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An effective Compliance Program is a living, breathing document. In order to be effective, it must become an integral part of your organization. It cannot simply lay dormant until an auditor shows up or a violation occurs. Rather, through the active application of the plan’s policies and procedures on a daily basis, active compliance can be achieved.

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