Search Results for: private overpayment

SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment.  Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant?

Dental Audits & Compliance /

(October 16, 2019): A Federal District Court Judge recently sentenced a Murfreesboro, TN dentist to prison and ordered that he pay restitution to TennCare (Tennessee’s Medicaid program). Regrettably, the types of improper billing practices cited by the government in the criminal Information filed against the defendant dentist aren’t that uncommon. This recent prosecution serves as […]

SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment.  Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant? Read More »

Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded.  What Steps are You Taking to Reduce Your Level of Risk?

Medicare, Medicaid & Private Payor Updates /

Big Changes to CMS Form 855 are on the Horizon[/caption] (September 18, 2019): On September 10, 2019, the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) published a Final Rule in the Federal Register entitled, “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider

Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded.  What Steps are You Taking to Reduce Your Level of Risk? Read More »

The Dangers of Billing Payors for the Services of a Non-Credentialed Dentist / Non-Participating Dentist

Dental Audits & Compliance /

(August 17, 2019): Over the last year, we have seen a significant increase in the number of Medicaid and private insurance audits of dental claims. A common trigger for these audits included instances in which a practice improperly billed for the services of a non-credentialed dentist while using the identification number of a credentialed provider.

The Dangers of Billing Payors for the Services of a Non-Credentialed Dentist / Non-Participating Dentist Read More »

OIG’s Renewed Interest in Orthotic Audits and Investigations: What Your DME Company Needs to Know

Medicare, Medicaid & Private Payor Updates /

(February 8, 2019): A series of recent reports out of the Department of Health and Human Services (HHS), Office of Inspector General (OIG) underscore the Federal government’s renewed concerns with respect to orthotic braces, including underlying medical need for these items. From 1994 to 2000, OIG issued half a dozen reports pertaining to orthotics audits

OIG’s Renewed Interest in Orthotic Audits and Investigations: What Your DME Company Needs to Know Read More »

Texas Prosecutors are Aggressively Targeting Criminal Home Health Fraud

Home Health & Hospice /

(January 9, 2019): Despite real progress being made with respect to regulatory compliance, home health agencies, their owners, and affiliated health care professionals (such as referring / supervising physicians, therapists and staff) remain under strict government scrutiny. The government’s efforts to investigate and prosecute home health fraud cases have been especially evident in Texas. In

Texas Prosecutors are Aggressively Targeting Criminal Home Health Fraud Read More »

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements?

Dental Audits & Compliance /

(January 3, 2019): Slowly but surely, the percentage of adults and children with dental insurance coverage benefits has gradually climbed. These increases have been driven, at least in part, by several factors. First, despite the fact that traditional Medicare does not cover routine dental services, a number of Medicare Advantage plans are now offering coverage

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements? Read More »

Audits of Telehealth Services are Increasing. Do Your Telehealth Services Meet Applicable Requirements?

Medicare, Medicaid & Private Payor Updates /

(Updated September 22, 2019): The use of “telehealth” technologies to diagnose and treat patients can be used to address provider shortages, improve patient access to otherwise unavailable specialized services, reduces costs, and provides an effective way to monitor the status of patients from long distances. The many benefits of telehealth have been readily recognized by

Audits of Telehealth Services are Increasing. Do Your Telehealth Services Meet Applicable Requirements? Read More »

Mobile Dentistry in Texas – An Overview of Regulatory Risk Areas to be Considered

Dental Audits & Compliance /

(December 7, 2018): Each state sets their own licensure requirements, rules and regulations regarding the practice of dentistry, all of which are subject to change. While there are differences from state to state, the approach taken by most states with respect to the practice of dentistry is fairly consistent. After conducting a review of several

Mobile Dentistry in Texas – An Overview of Regulatory Risk Areas to be Considered Read More »

Areas of Practice

Health Care Law Liles Parker attorneys have the litigation experience, health care regulatory knowledge, and counseling skills necessary to efficiently resolve health care issues at the lowest possible level, before they escalate into a more significant problem Learn More Unified Program Integrity Contractor (UPIC) Audits HIPAA Audits and Compliance False Claims Act Matters and Cases

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Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant?

Medicare, Medicaid & Private Payor Updates /

(July 16, 2018): Do you provide Transcranial Magnetic Stimulation care and treatment services? If so, you need to ensure that your medical necessity, documentation, coding and billing practices fully comply with applicable statutory, regulatory and administrative guidelines. In recent weeks, a flurry of prepayment review letters from Medicare Administrative Contractors (MACs) have been sent to

Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant? Read More »