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28 Jun 2023, 6:53 am by Robert Liles
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]
14 Jun 2023, 8:02 am by Robert Liles
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]
29 May 2023, 10:00 am by Robert Liles
Medicare Advantage Plans are Aggressively Denying Claims – Administrative Appeals are Growing (May 25, 2023): According to the latest data released by the Centers for Medicare and Medicaid Services (CMS), beneficiaries participating in Medicare Advantage[1] plans now surpass those enrolled in original Medicare plans. [read post]
8 May 2023, 12:28 am by Christin Thompson
Medicare Exclusion Risks: Employing Excluded Individuals Can Result in Significant Administrative, Civil and / or Criminal Liabilities (May 8, 2023): One of the most severe administrative sanctions available under the Social Security Act stems from the authority of the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS)[1] to “exclude” individuals and entities from participating in Federal health care programs.[2] While the… [read post]
2 Dec 2022, 12:30 pm by John Ross
[Veterans' benefits, Robert's Rules of Order, and Floribama.] [read post]
10 Oct 2022, 5:01 am by Robert Liles
Civil Investigative Demands (CIDs) & Collateral Enforcement Risks: A Review (October 12, 2022): The False Claims Act is the primary civil enforcement tool utilized by our government today. [read post]
5 Oct 2022, 4:11 am by Robert Liles
Enforcement Efforts Targeting Aquatic Therapy Providers and CPT Code 97113 Claims (October 3, 2022): Aquatic therapy is a common method of rehabilitation and maintenance for several types of injuries and conditions, and the practice is widely accepted by Medicare, Medicaid and many private payors. [read post]
24 May 2022, 11:28 pm by Robert Liles
Balloon Sinuplasty Fraud / Balloon Dilation Fraud Prosecutions are Increasing Around the Country (May 25, 2022): In recent years, federal regulators have initiated a significant number of audits and investigations examining the improper billing of claims for balloon sinuplasty / balloon dilation procedures by Otolaryngologists (commonly referred to as Ear, Nose and Throat (ENT) physicians. [read post]
20 May 2022, 9:56 am by Robert Liles
VA Acupuncture Audits of Non-VA, Community Providers are Increasing (May 20, 2022): Acupuncture audits and investigations by federal, state and private payors have greatly expanded in recent years. [read post]
12 May 2022, 6:59 am by Robert Liles
State and Federal Hospice Audit and Investigation Efforts are Expanding in 2022 (May 12, 2022): Hospice agencies are again the focus of both state and federal investigators and prosecutors around the country. [read post]
22 Apr 2022, 7:51 am by Robert Liles
The Criminalization of Pain – In 2022, DOJ is Aggressively Investigating and Prosecuting MDs, NPs and PAs for Violations of the Controlled Substances Act (April 19, 2022): Despite our government’s best efforts, opioid overdose deaths in America are continuing to spiral out of control. [read post]
23 Feb 2022, 4:27 am by Robert Liles
A Review of Dental Enforcement in 2021 and a Look at What Dentists Should Expect in 2022 (February 22, 2022): The treatment and business challenges presented by COVID-19 over the last two years have been especially demanding on dentists and their practices. [read post]