Health Care Law

Miscoded Evaluation and Management Services Cost Medicare $6.7 Billion

Medicare, Medicaid & Private Payor Updates /

(June 25, 2014) Officials at the Department of Health and Human Services, Office of Inspector General (OIG) recently examined medical records from 2010 for claims related to evaluation and management services (E/M services). The results are astounding. OIG determined that Medicare inappropriately paid $6.7 BILLION for E/M services that year due to claims that were […]

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Consequences of HIPAA Non-Compliance

Medicare, Medicaid & Private Payor Updates /

(June 16, 2014): It has been over a year since the effective date of the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) comprehensive modifications to the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, Enforcement and Breach Notification Rules, commonly referred to as the Omnibus Rule. Covered entities were

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Medicare ALJ Appeals of Denied Home Health Claims

Home Health & Hospice /

(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative

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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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