ZPIC

2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 11, 2011): ZPIC audits and ZPIC suspension actions are a serious risk facing non-hospital providers today. As you recall at the end of 2010 we identified the “Top Ten Health Care Compliance Risks for 2011”. The purpose of this article is to analyze two of those risks; Zone Program Integrity Contractor (ZPIC) audits and […]

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Top Ten Health Care Compliance Risks for 2011

Medicare, Medicaid & Private Payor Updates /

(December 31, 2010): In case you missed it, Congress, President Obama and the healthcare regulators had a banner year with respect to regulatory activism in 2010. Over the next several weeks we will be releasing a series of articles on our website addressing the compliance risk areas facing your organise dramatic changes and the compliance

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CMS Authorizes Medicare Appeals by Fax and Secured Internet

Medicare, Medicaid & Private Payor Updates /

(November 21, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating that this change

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South Texas Home Health Fraud Case Results in Nurse Prosecution

Home Health & Hospice /

(October 9, 2010): The U.S. Attorney’s Office for the Southern District of Texas recently issued a Press Release announcing the conviction of a South Texas nurse who worked for a home health company. She allegedly admitted falsifying and forging encounter forms used when providing care for Medicare beneficiaries. This case is merely the latest example

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Robert W. Liles Invited to Speak at the WDTX DOJ Working Group for Health Care Fraud Meeting

Firm News /

(September 12, 2010): Robert W. Liles, Managing Partner at Liles Parker, has been asked to serve as the main speaker at the quarterly DOJ Working Group conference sponsored by the U.S. Attorney’s Office for the Western District of Texas. The Working Group consists of Federal civil and criminal Prosecutors, FBI agents, HHS-OIG agents and investigators,

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DOJ is Using Medicare Billing Data to Target Health Care Providers

Medicare, Medicaid & Private Payor Updates /

(August 31, 2010): Last week, department heads of the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS), met in Los Angeles, CA and conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.” Following-up on a similar conference held in Miami, DOJ Attorney General Eric

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Health Data Insights Begins Medical Necessity Reviews

Medicare, Medicaid & Private Payor Updates /

(August 30, 2010): Health Data Insights (HDI), the Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC) responsible for auditing health care providers in Region D, has announced it will immediately begin reviews on previously approved projects which involve the medical necessity of selected inpatient DRG payments. A complete list of the medical

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Can a ZPIC Extrapolate the Alleged Damages in a Medicare Claims Audit?

Medicare, Medicaid & Private Payor Updates /

(July 12, 2010): Can a ZPIC extrapolate the alleged damages in a case. If the ZPIC’s statistical methodology is properly handled, the extrapolation of alleged damages can be a surefire way of destroying a provider’s practice. We’ve known it for years and yet the government’s passion for statistical sampling only seems to be growing. This

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Responding to a Search Warrant Executed at Your Health Care Practice or Clinic

Medicare, Medicaid & Private Payor Updates /

(June 1, 2010): Like most honest health care providers, you may believe that search warrants are only executed by the government in connection with the investigation of nefarious characters and criminals. Unfortunately, that just isn’t the case. The Federal government has increasingly utilized search warrants as a first-strike investigative tool. In fact, the execution of

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For AdvanceMed, it’s Not Personal, Just Business – Big Business

Medicare, Medicaid & Private Payor Updates /

(March 26, 2010): Over the next few days, we will be publishing a brief overview of specific Zone Program Integrity Contractors (ZPICs) (such as AdvanceMed) – the companies who have been hired by CMS to conduct the medical reviews of Part A and Part B health care providers around the country. As we have previously

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