Healthcare Law

Physician Office OSHA Standards Present a Number of Compliance Challenges

Medicare, Medicaid & Private Payor Updates /

(July 2, 2014): The Occupational Safety and Health Administration (OSHA) is an agency of the United Stated Department of Labor. Its purpose is assure safe and healthy working conditions for all working men and women by setting and enforcing standards and by providing education, training, outreach, and assistance. OSHA creates standards and guidelines that apply […]

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HIPAA Encryption is the Best Way to Avoid a Violation

Medicare, Medicaid & Private Payor Updates /

(May 29, 2014): On April 22, 2014, the U.S. Department of Health and Human Services Office for Civil Rights (HHS-OCR) announced that it had entered into resolution agreements with two entities for $1,725,220 and $250,000, respectively, to resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. The main

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Texas Providers Are Required by Law to Have a Medicaid Compliance Program

Medicare, Medicaid & Private Payor Updates /

(February 21, 2014): If you are a participating provider in the Texas Medicaid program, do you have a Medicaid compliance program in place for your practice? If the answer to this question is “no” – or, more worrisome, if you are asking, “What is an effective compliance program?” – you are violating the terms of

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CMS and Contractors Must Address EHR Fraud Vulnerabilities

Medicare, Medicaid & Private Payor Updates /

(February 7, 2014): A new report from the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) finds that the Centers for Medicare and Medicaid Services (CMS) and its contractors have adopted few Medicare program integrity practices to address electronic health record (EHR) fraud vulnerabilities. These EHR fraud vulnerabilities include

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Home Health Face-to-Face Encounters: Is Your Agency Performing it Properly?

Home Health & Hospice /

(February 6, 2014): Before a Medicare beneficiary may be deemed eligible for home health services, a provider must perform a face-to-face encounter with the patient and certify that he or she is eligible for care. More importantly, the certifying physician must properly document this encounter. However, practitioners are commonly finding that their documentation do not

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Dentist Indicted on Nearly 200 Counts of New Hampshire Medicaid Dental Fraud

Dental Audits & Compliance /

(January 3, 2014): A 57-year-old Queen City, New Hampshire dentist has recently been charged with 189 counts of Medicaid dental fraud. As a result, he could face many years in prison. The New Hampshire Medicaid program is a joint federal and state-funded health care program that serves individuals and families in that state who meet

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EHR Cloning Practices Can Lead to Medicare Audits

Medicare, Medicaid & Private Payor Updates /

(December 26, 2013): The Department of Health and Human Services (HHS) has long viewed the adoption of Electronic Health Records (EHRs) as a way to better coordinate care, improve the quality of care, reduce unnecessary paperwork, and eliminate duplicative medical testing. Based, at least in part, on these beliefs, Congress authorized incentive payments to encourage

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Dentist Alleged to Have “Systematically Bilked” MassHealth Dental Fraud Scheme

Dental Audits & Compliance /

(December 23, 2013): A recent state audit of a Massachusetts dentist has reportedly uncovered numerous instances of MassHealth dental fraud, alleging that dentist fraudulently billed the state’s “MassHealth Insurance Program”. According to the state’s auditor, the dentist “systematically bilked the MassHealth Dental Program”. In all, the audit claims to have found over $150,000 in improper

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Hospital Outpatient Dental Services are Being Audited

Dental Audits & Compliance /

(December 4, 2013): Generally, Medicare does not cover hospital outpatient dental services. Under the general exclusion provisions of the Social Security Act, items and services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth (e.g., preparation of the mouth for dentures or removal of diseased teeth

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Is Your Dental Practice Prepared to Undergo a Medicaid Dental Audit?

Dental Audits & Compliance /

(November 25, 2013): The link between oral health and overall health has been increasingly acknowledged over the years. Emphasis has been placed on children’s oral health in particular. In fact, the Children’s Health Insurance Program Re-authorization Act of 2009 (CHIPRA) mandates that “child health assistance provided to a targeted low-income child shall include coverage of

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