"Nationwide Healthcare Lawyers"
Today, it is more essential than ever that health care providers take great care when assessing a patient’s clinical needs and determining which care and treatment is medically necessary. Once this decision is made, it is imperative that health care providers submitting claims to governmental and private payors fully understand their obligations under the law […]
Eight Elements of a Payable Medical Claim Read More »
Ashley Morgan is a partner at Lliles Parker. Ms. Morgan focuses her practice on regulatory health care compliance matters, fraud and abuse, and reimbursement issues. Ms. Morgan represents health care providers across the country in connection with a wide variety of health law issues including coverage disputes, documentation concerns, compliance, medical board complaints, and exclusion
Ashley Morgan, J.D., C.P.C., C.M.R.S., C.M.C.O., B.S. Read More »
The civil False Claims Act [1] (31 U.S.C. §§ 3729-3733), is the primary civil health care fraud enforcement tool utilized by the federal government. As discussed below, the False Claims Act is an extraordinarily useful statute for government prosecutors, both in terms of ease of use and in terms of the damages that may be
False Claims Act Matters and Cases — An Overview Read More »
(January 3, 2021): In recent months, we have seen a significant rise in the number of Medicare and Medicaid audits focusing on the medical necessity of certain outpatient Respiratory Viral Panels (CPT Code 87633) and Gastrointestinal Pathogen Panels (CPT Code 87507). Unfortunately, many of these audits seem to be merely the latest example where payors
Audits of Respiratory (CPT Code 87633) / Gastro (CPT Code 87507) Panels are Ongoing. Read More »
The False Claims Act (31 U.S.C. §§ 3729-3733), was first enacted in 1863 by a Congress concerned that suppliers of goods to the Union Army during the Civil War were defrauding the Army. Over the life of the statute it has been interpreted on hundreds of occasions by Federal courts (which have sometimes issued conflicting
False Claims Act Matters and Cases Read More »
Liles Parker attorneys have decades of experience practicing health care law. Several of our attorneys served as federal prosecutors and held significant positions at the U.S. Department of Justice. Our health care transactional and regulatory attorneys have the knowledge and counseling skills necessary to efficiently resolve your health care business issues at the lowest possible level, before
Healthcare Law Representation Read More »
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) has historically emphasized the importance of “square dealing” with government supported health care programs and urged health care providers to adopt effective practices and procedures that are designed to promote compliance with applicable statutory and regulatory requirements and detect and prevent fraud.
OIG Provider Self-Disclosure Considerations Read More »
(Updated December 2020): Of the many contractors working for the Centers for Medicare and Medicaid Services (CMS), Unified Program Integrity Contractors (UPICs) are by far the serious financial threat to your practice, home health, hospice or DME company. A UPIC audit is serious business. Simply put, the UPIC program was intended to consolidate the work
A UPIC Audit is Serious Business — Is Your Office Prepared? Read More »
(September 15, 2020): There are approximately 1.4 million active duty service members in our country. These active duty service members have approximately 1.9 million dependents. Our military also consists of almost a million reserve and national guard participants. Depending on an individual’s status, these active duty service members, their dependents, and reservists are likely eligible
United Concordia Dental and its SIU are Actively Auditing Dentists Around the Country. Read More »
(March 3, 2020): In recent years, Federal prosecutors around the country have increasingly relied on Civil Investigative Demands when investigating civil False Claims Act matters and cases.[1] It’s easy to see why the government has continued to focus its civil enforcement efforts on alleged violations of the False Claims Act. Let’s look at the numbers
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