Search Results for: private overpayment

Private Insurance Overpayment & Patient Credit Balance Repayment Obligations

Most health care providers and suppliers have a solid understanding of their obligation to repay overpayments that may be owed to Medicare, Medicaid and other Federal health benefit plans.[1] Unfortunately, they may not fully understand that overpayments never belong to them, even if the monies are not owed to a government payor. If your practice […]

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Overview of Dental Claims Audits and Investigations by Medicaid and Private Payors in 2019

Dental Audits & Compliance /

(March 4, 2020): Many dentists and dental practices around the country are glad that 2019 is behind us.  Last year was a banner year for law enforcement investigators and administrative auditors of dental claims.  Federal and State prosecutors around the country actively pursued both civil and criminal cases against individual dentists for a variety of

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Individual Liability for Medicare Overpayment Claims

Medicare, Medicaid & Private Payor Updates /

(February 24, 2015): Medicare recently finalized regulations allowing enrollment as a Medicare provider to be denied if any owner or control person of the enrolling provider is affiliated with another provider which owes money to Medicare. These regulations are based on sections of the 2010 Affordable Care Act (ACA). They provide CMS an indirect means

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Individual Liability for Medicare Overpayment Claims

Medicare, Medicaid & Private Payor Updates /

(October 19, 2012): This article addresses the case where an individual or “natural person” owns an interest in a Medicare health care provider which is incorporated[1] under the laws of a state, as a corporation, limited liability company, limited partnership, or another type of legal person. The individual may be a shareholder, member, limited partner,

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What are a Dentist’s Medicaid Overpayment Obligations? Part I

Dental Audits & Compliance /

(April 24, 2012): While considerable attention has been paid to the Affordable Care Act (generally referred to as “Health Care Reform”) and its requirement that “identified overpayments” be promptly repaid to the government, it is important to keep in mind that this repayment obligation is not new – it has long been firmly in place.

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Providers Should Exercise Caution When Handling Overpayments — More Than Likely, You Can’t Keep It, Even if the Payor Doesn’t Want it Back!

Medicare, Medicaid & Private Payor Updates /

(July 15, 2010): When handling Medicare overpayments, providers must exercise caution. Since the May 2009 passage of the Fraud Enforcement and Recovery Act (FERA) and subsequent enactment of the Affordable Care Act (ACA), we’ve heard a lot about how the government looks at Medicare overpayments and how providers should handle them. Prior to the clarification

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CMS CRUSH Update Providers Must Prepare for AI Driven Audits in 2026 - Featured Image - Liles Parker

CMS CRUSH Update: Providers Must Prepare for AI Driven Audits in 2026

Home Health & Hospice /

(June 5, 2026): Amid the publicity and fanfare of a White House Press Conference on February 25, 2026, Vice President J.D. Vance, Secretary Robert F. Kennedy[1], and Administrator Mehmet Oz, M.D.,[2] announced a new Medicare and Medicaid program integrity initiative known as the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).[3] Secretary Kennedy framed the initiative

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Transcranial Doppler Claims are Being Audited - Featuered Image - Liles Parker

Transcranial Doppler Claims are Being Audited. Are You Ready?

Medicare, Medicaid & Private Payor Updates /

(February 2, 2026): Neurologists, radiologists, and vascular surgeons around the country who perform Transcranial Doppler Ultrasound procedures are currently under the government’s regulatory microscope. Therefore, it is more important than ever that you review your business practices to confirm your transcranial doppler procedures fully meet applicable medical necessity, documentation, coding, and billing requirements. As discussed

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Dental Claim Audits and Investigations are Expected to Increase in 2026 - Featured Image - Liles Parker

Dental Claim Audits and Investigations are Expected to Increase in 2026

Dental Audits & Compliance /

(January 21, 2026): The past year has been rough for many dental practices around the country. After declining during COVID, government and private payor audits of dental claims rose sharply in 2024 and continued to increase in 2025. The question we are now being asked by our dental clients is whether these activities will continue

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