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20 Mar 2022, 9:14 am
The OIG Exclusion List of Individuals and Entities is Growing. [read post]
29 Oct 2021, 9:03 pm
The Collateral Enforcement Risks of DOJ Civil Investigative Demands (CIDs) Issued in False Claims Act Matters and Cases (October 21, 2021): The False Claims Act1 remains the primary civil enforcement tool utilized by the U.S. [read post]
19 Jan 2021, 8:43 pm
Prepayment Reviews and Audits of Medicare Claims are Ongoing. [read post]
29 Oct 2021, 9:03 pm
The Collateral Enforcement Risks of DOJ Civil Investigative Demands (CIDs) Issued in False Claims Act Matters and Cases (October 21, 2021): The False Claims Act [1] remains the primary civil enforcement tool utilized by the U.S. [read post]
25 Mar 2020, 10:00 am
COVID-19 Outbreak Update – Two Recent Updates From CMS Affecting Relief From Quality Reporting Requirements, And New Targeted Plan For Healthcare Facility Inspections Including Provider-Self Assessment Tool For Infection Control (March 25, 2020): As our clients and all members of the health care community are acutely aware, the challenges raised by the Coronavirus / COVID-19 outbreak are critical and widespread. [read post]
28 Jun 2023, 6:53 am
Texas HHSC-OIG is Ramping-Up its Investigations of Medicaid Pediatric Telemedicine Claims (June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. [read post]
12 Apr 2018, 8:48 am
CBRs for Spinal Orthoses (CBR201803): What Do You Need to Know? [read post]
9 Mar 2020, 10:26 am
Medicare Revocation Actions Under 42 CFR § 424.535(a) are Rising Around the Country! [read post]
30 Sep 2019, 2:08 pm
OIG Has Identified Common Errors by High-Risk Home Health Agencies. [read post]
26 Jan 2023, 8:27 am
TPE Audits: The Process & Expected Targets in 2023 (January 26, 2023): Since the inception of the pilot program in 2015, the Targeted Probe and Educate Audit (TPE audit) program has effectively been a double-edged sword for most providers. [read post]
9 Jan 2021, 2:00 pm
Eight Elements of a Payable Claim are an Essential Tool When Preparing for a UPIC Audit (Updated January 9, 2021): Each year, our attorneys and paralegals review and assess literally thousands of Medicare claims which have been audited (and denied) by Unified Program Integrity Contractors (UPICs) and other contractors working for the Centers for Medicare and Medicaid Services (CMS). [read post]
3 Jan 2021, 3:07 pm
Audits of Respiratory (CPT Code 87633) / Gastro (CPT Code 87507) Panels are Ongoing. [read post]
15 Aug 2007, 11:16 am
Edward and Kelly Keisel, a 7-page opinion, Judge Riley writes:Appellant-Defendant, James Lile (Lile) d/b/a Lile's Body Shop and Trailer Sales (Lile's), appeals the trial court's judgment ordering him to refund Appellees-Plaintiffs, Edward (Edward) and Kelly Kiesel (Kelly) (collectively, the Kiesels), $3,059.00 plus post-judgment interest. [read post]
6 Jun 2012, 10:47 am
Liling Yue, Professor of China University of Political Science and Law. [read post]
13 Aug 2019, 1:28 pm
Genetic Testing Fraud Prosecutions are on the Rise Around the Country. [read post]
17 Aug 2019, 11:56 am
The Dangers of Billing Payors for the Services of a Non-Credentialed Dentist / Non-Participating Dentist (August 17, 2019): Over the last year, we have seen a significant increase in the number of Medicaid and private insurance audits of dental claims. [read post]
25 Mar 2020, 3:41 pm
Section 1135 Waiver Issues and COVID-19 (March 25, 2020): On January 31, 2020, Secretary Alex Azar, of the US Department of Health & Human Services (HHS), used his authority under the Public Health Service Act to declare a public health emergency in the United States.[1] Secretary Azar determined that a public health emergency had existed nationwide since January 27, 2020. [read post]
28 Sep 2020, 8:58 am
Home Health Revocation Actions by Medicare are Expanding Around the Country (September 28, 2020): Last September, CMS published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process. [read post]
28 Sep 2020, 8:58 am
Home Health Revocation Actions by Medicare are Expanding Around the Country (September 28, 2020): Last September, CMS published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process. [read post]
14 Jun 2023, 8:02 am
HHS Departmental Appeals Board (DAB) Appeals (June 15, 2023): The Department of Health and Human Services (HHS) is enormous, employing more than 80,000 individuals[1] who work in a dozen operating divisions and an even greater number of independent offices that report directly to the Office of the Secretary.[2] One of these independent offices is the HHS Departmental Appeals Board (DAB or Board). [read post]
