"Nationwide Healthcare Lawyers"
(April 13, 2026): Physicians, home health agencies, and hospices constantly strive to ensure the well-being of their patients. Unfortunately, over the past few years, scores of providers have found themselves at odds with the Centers for Medicare & Medicaid Services (CMS) and its contractors. If you think “It Can’t Happen to Me,” consider this – […]
Staying Ahead of the Surge in Medicare Revocation Actions Read More »
(September 28, 2020):Last September, CMS published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” [1] Among its many chan ges, the Final Rule significantly expanded the reasons that may be asserted by the Centers for Medicare and Medicaid Services (CMS) when revoking a health
Home Health Revocation Actions by Medicare are Expanding Around the Country Read More »
(September 25, 2020): In recent years, many individuals (especially younger members of our work force) have embraced the chance to supplement their income through short-term engagements in the “gig economy.” Notably, both professionals and non-professionals alike have found flexible, part-time opportunities online, allowing them to work remotely as independent contractors. A number of physicians, nurse
Medicare Revocation Actions Related to Telemedicine Rising! Read More »
(UPDATE: March 9, 2020): A Medicare revocation action can destroy the financial viability of your practice. Moreover, effective November 4, 2019, the reasons for which a health care provider or supplier may have its Medicare billing privileges revoked have greatly expanded. Our article titled “42 CFR Sec. 424.535(a) Medicare Revocation Actions — Your Medicare Billing
Responding to a Medicare Revocation Action Effective Prior to November 4, 2019 Read More »
(March 9, 2020): Last September, the Centers for Medicare and Medicaid Services (CMS) published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” The Final Rule under 42 CFR Sec. 424.535(a) was published in order to implement sections 1866(j)(5) and 1902(kk)(3) of the Social Security
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
(December 14, 2017): The Centers for Medicare and Medicaid Services (CMS) has engaged various types of outside contracting entities to perform program integrity functions on behalf of the Medicare program. At the present time, Uniform Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs) are very aggressive when it comes to referring evidence of
Revocation of Your Medicare Billing Privileges Read More »
(September 16, 2014): Consider the following scenario. You own a durable medical equipment (DME) company that you run out of a leased location in a local office building. Your customers are a mix of privately insured and Medicare/Medicaid beneficiaries. You’ve been in business for about 10 years, but money is tight and you need to
Medicare Revocation Action: Steps for Avoiding and Appealing Read More »
(July 15, 2026): For health care practitioners, providers, and suppliers, the National Practitioner Data Bank (NPDB) represents one of the most significant and least understood forces in their professional lives. What began as an effort by Congress to track incompetent physicians has evolved into a massive, permanent repository of medical malpractice payments, disciplinary actions, and
A Negative NPDB Report Can End Your Career— Know Your Rights Read More »
(June 23, 2026): This week, the U.S. House of Representatives’ Appropriations Committee approved draft Fiscal Year (FY) 2027 appropriations language covering the Department of Health and Human Services (HHS). If ultimately enacted, this appropriations language will bar the use of federal funds to implement the Centers for Medicare & Medicaid Services’ (CMS) “Wasteful and Inappropriate
House Seeks to Defund the WISeR Program – Providers Won’t See Relief Any Time Soon Read More »
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