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CMS has Ended its Moratorium on New Home Health Agencies in Texas, Illinois, Michigan and Florida. Unfortunately, the Lifting of the Moratorium Isn’t Necessarily a Good Thing for Existing Home Health Agencies.

Home Health & Hospice /

(February 19, 2019): CMS has now ended, at least for the current time, the moratorium that it placed on the approval of new home health agencies. At the same time, home health providers that operate in Illinois, Ohio, North Carolina, Florida and Texas, and potentially other states within the Palmetto/JM jurisdiction (Alabama, Arkansas, Georgia, Indiana, […]

CMS has Ended its Moratorium on New Home Health Agencies in Texas, Illinois, Michigan and Florida. Unfortunately, the Lifting of the Moratorium Isn’t Necessarily a Good Thing for Existing Home Health Agencies. Read More »

Is a RAC Prepayment Review of Your Medicare Claims on the Horizon?

Medicare, Medicaid & Private Payor Updates /

(December 19, 2011): As you know, RACs play an important role in the identification of Part A and Part B overpayments. Since the inception of the RAC Demonstration Project in 2005, RACs have successfully identified a number of improper claims, denying payment for reasons ranging from mere technical errors to broad concerns about medical necessity.

Is a RAC Prepayment Review of Your Medicare Claims on the Horizon? Read More »

“A Verbal Contract Isn’t Worth the Paper on Which it is Written.”

Regulatory Issues | Privacy | Other /

(November 21, 2011): After twenty years of practicing law, I still receive many calls from folks who have had a deal gone bad, money taken, partnerships that defrauded them, et cetera; of course, the first thing I ask is what did the contract say? The response I most often hear is, “there is no written

“A Verbal Contract Isn’t Worth the Paper on Which it is Written.” Read More »

What You Need to Know Before Signing a Physician Employment Agreement.

Regulatory Issues | Privacy | Other /

(June 9, 2011): After 20 years of practicing law I can say that most phone calls I receive from a potential client are after a contract has been signed. Unfortunately, today’s physician employment agreements are multiple pages long with small print and certainly not written for easy reading or common sense applicability. Contracts are certainly

What You Need to Know Before Signing a Physician Employment Agreement. Read More »

New Face-to-Face Requirements for Hospices and Home Health Agencies

Home Health & Hospice /

(May 8, 2011): Over the last year, both hospice and home health agencies have faced a number of regulatory challenges, including but not limited to the face-to-face issue. In many instances (including the new requirement discussed below), these regulatory changes have been implemented in an effort to better ensure that the services ordered are reasonable

New Face-to-Face Requirements for Hospices and Home Health Agencies Read More »

Predictive Modeling: ZPICs Using Data Mining to Identify Medicare Fraud

Medicare, Medicaid & Private Payor Updates /

(April 15, 2011): Over the last decade, the Centers for Medicare and Medicaid Services (CMS) and its contractors (Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Recovery Audit Contractors (RACs)), have steadily assembled an extensive database of the coding and billing practices of Medicare providers around the country. Analyzing this data, contractors have

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NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5.

Medicare, Medicaid & Private Payor Updates /

(April 10, 2011): Last week, it was announced that NCI, Inc., one of the nation’s most successful information technology companies had acquired the outstanding capital stock of AdvanceMed Corporation (AdvanceMed), an affiliate of CSC. While the acquisition went largely unnoticed by the health care provider community, the transaction may, in fact, be quite significant. With

NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5. Read More »

HEAT Strike Force Update: Prosecutions in Texas Increased in March 2010

HEAT Strike Force, Regulatory Issues | Privacy | Other /

(April 3, 2010): The Federal government is taking considerable steps to stop Medicare fraud and abuse. Notably, the number of publicly-disclosed HEAT Strike Force investigations and prosecutions in Texas significantly increased last month. Two of the cases disclosed involved mental health professionals: A Psychologist was convicted of health care fraud and money laundering, in connection

HEAT Strike Force Update: Prosecutions in Texas Increased in March 2010 Read More »