"Nationwide Healthcare Lawyers"
(November 12, 2012): The AHA Supports the Medicare Audit Improvement Act of 2012. Is this Legislation Going to Help Physicians or Not? On October 16, 2012, a new bill was introduced by Representative Sam Graves (R-MO) entitled the “Medicare Audit Improvement Act of 2012”. This legislation was immediately supported by the American Hospital Association (AHA), […]
(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,
Individual Liability for Medicare Overpayment Claims Read More »
(September 26, 2012): From the start, Zone Program Integrity Contractors (ZPICs) have worked to separate themselves from their proverbial “bounty hunter” peers – Recovery Audit Contractors (RACs). As you may know, ZPICs are paid on a contractual basis by the Centers for Medicare & Medicaid Services (CMS), instead of by how much money they return
A CMS ZPIC Contract is Quite Lucrative Read More »
(July 30, 2012): Baton Rouge Medicare audits are on the rise. Here’s a summary of the Medicare contractors who service the healthcare providers and suppliers in Baton Rouse, LA: Baton Rouge Population: 230,139 (2011 Census) Medicare Administrative Contractor (MAC) (Parts A/B): Novitas Solutions LLC (a/k/a Highmark) DME MAC (Region C): CIGNA Government Services Administrators LLC
Baton Rouge Medicare Audits by CMS Program Integrity Contractors. Read More »
(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were
Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers Read More »
(November 16, 2011): Many providers believe that their practice is a normal one – average billings, average patient load, costs of care which are consistent with industry standards – and that they need not be concerned with undergoing a Medicare post payment audit for being a “statistical outlier.” As you may know, Medicare and Medicaid
Data Mining is Being Used for ZPICs Targeting Purposes Read More »
(August 14, 2011): Home health agencies in Texas and Oklahoma remain under considerable scrutiny by Medicare contractors tasked with identifying fraud and abuse perpetrated against the Medicare Trust Fund. As discussed below, these Medicare contractors have a number of tools at their disposal, many of which can effectively place a home health agency in financial
Health Integrity Audits of Texas and Oklahoma Home Health Agencies are on the Rise. Read More »
(July 24, 2011): Has your Texas physician practice, home health agency, hospice, DME company or PT / OT / ST clinic been audited by a Zone Program Integrity Program (ZPIC)? If not, it may only be a matter of time. Despite your best efforts to follow Medicare’s directives, your organization may still be identified as
Ten Recommendations to Improve Medicare Compliance and Prepare for a ZPIC Audit Read More »
(July 16, 2011): As Zone Program Integrity Contractor (ZPIC) audits of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) companies continue to climb, the Department of Health and Human Services, Office of Inspector General (HHS-OIG), has now reported that more than one-half of the recent power wheelchair claims by Durable Medical Equipment (DME) suppliers were
(July 10, 2011): In response to a report released by the Office of the Inspector General (HHS-OIG) of the Department of Health and Human Services, the Centers for Medicare and Medicaid Services (CMS) recently signaled that it will direct Medicare contractors to more closely scrutinize the billing patterns of skilled nursing facilities (SNFs). In fact,
ZPICs are Conducting SNF Medicare Audits Around the Country! Read More »