"Nationwide Healthcare Lawyers"
(July 28, 2022): The business side of medicine has changed considerably over the last decade. Health care laws, regulations, and administrative policies are constantly evolving. A number of these changes have impacted health care practices, billing companies, and the third-party billing contracts executed between these parties. From its earliest beginnings, the majority of third-party billing […]
(May 25, 2022): In recent years, federal regulators have initiated a significant number of audits and investigations examining the improper billing of claims for balloon sinuplasty / balloon dilation procedures by Otolaryngologists (commonly referred to as Ear, Nose and Throat (ENT) physicians. Depending on the specific facts in each case, the improper billing of balloon
(May 20, 2022): Acupuncture audits and investigations by federal, state and private payors have greatly expanded in recent years. One of the most active players conducting acupuncture audits today is the U.S. Department of Veterans Affairs. (VA). It is worth noting that long before traditional Medicare even considered covering acupuncture services,[1] the VA made these
VA Acupuncture Audits of Non-VA, Community Providers are Increasing Read More »
(February 22, 2022): The treatment and business challenges presented by COVID-19 over the last two years have been especially demanding on dentists and their practices. Between the lockdowns and a hesitancy by many individuals to schedule non-emergent dental care, many dental practices have found it tougher than ever to maintain previous levels of profitability. Not
A Review of Dental Enforcement in 2021 and a Look at What Dentists Should Expect in 2022 Read More »
(October 21, 2021): The False Claims Act [1] remains the primary civil enforcement tool utilized by the U.S. Department of Justice (DOJ). While the results of Fiscal Year (FY) 2021 have not yet been published, settlements and judgements in FY 2020 exceeded $2.2 billion. Of this total, $1.8 billion were related to the health care
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., C.P.C., C.M.C.O., 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 are
(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 and
Special Investigative Unit (SIU) Audits Read More »
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